The Pursuit

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I wish I were perfect. At least I wish I were a perfect doctor. As a human I’m willing to accept that I make errors and sometimes fall short or make missteps in life. But, when others are involved, it seems that perfection is demanded. And it isn’t just me demanding it of myself, but it seems to be the public perception that all physicians must be perfect in their care. As people we may be flawed, but as doctors, flawlessness is required. Perhaps it is this dogmatic cultural belief that creates the angst we feel when we make a mistake.

Placing all of our efforts into being perfect physicians may not be the best or most gratifying way to live our professional lives.

I’ve been in residency three years now, and I don’t think I’ve had as many shifts where I could say that everything went completely as planned, or that I did everything correctly. Each day there is something I do wrong. Sometimes it’s a medical error, sometimes it’s in the way I address a patient or coworker. Mistakes may be large or small, but they’re always present. But now nearing the end of training it’s becoming more and more evident that despite steady improvement, I will not graduate a purified physician bereft of defects. Despite the best of efforts or intentions, my human nature of imperfection will always spill over into my career as a caretaker for others. And it will for all of us. Speak with the most senior physician you can find and they’re nearly guaranteed to readily admit that they still make mistakes after 20, 30, or even 40 years of practice.

But as time marches on, and litigation increases, the pressure to perform becomes increasingly stiff. How do we reconcile what is demanded of us by society with our limits as fallible individuals? Even more, how do we reconcile our faults with our own demands of ourselves? Too little contemplation of our mistakes leads to unwarranted self-complacency and the arrogance often noted in the villainization of physicians by the media. Too much contemplation leads to feeling the consternating burn of the job. It makes you think you may have been better off selling sandwiches for a living. Somewhere in between is a healthy balance, but finding it is the tricky part. As physicians, and especially as emergency care providers, we’ve picked a profession that reveals the imperfections of others and lays bare their weaknesses in a way no other job does. That probably plays a part in the jadedness and burn out we experience: different day, same stuff. Same imperfect people… just like us.

It seems that many times we just pass over how readily we criticize others for their mistakes, yet not realizing that we would do the same thing if we were in their position. There is sometimes created an “us versus them” mentality in the department, and part of that stems from a perceived relatively higher morality. The truth is, there is no partition between us. We are all human, we’re just as imperfect as each and every one of our patients, but we’re expected to be perfect in our care. And even though we never will be, maybe we should be. We are the healers.

Despite all of the emphasis on our performance outcomes, and all of the build-up surrounding Press Ganey, our shortcomings may just fall to the wayside — sometimes, perfection ultimately just doesn’t matter. There are patients who will die no matter what your actions are on their behalf. There are patients who will get better and do just fine, no matter how you treat them; or if you even treat them at all. Many times it’s not about the “art” or “practice” of medicine, and no degree of astute diagnostic skill or depth of knowledge will make the difference. And that’s just life.

So placing all of our efforts into being perfect physicians may not be the best or most gratifying way to live our professional lives. While nurturing the idealist within us that tells us we can be perfect is a healthy way to progress, realism tells us that some goals can’t be achieved. We shouldn’t feel let down or below the calling when we fail, because if we are focusing on improvement, that will keep us honest as physicians. It’s not the attainment of perfection, it’s just the pursuit.

Nathaniel Mann, MD

Nathaniel Mann, MD

Nathaniel Mann, MD is a resident at the University of Cincinnati and was elected to the EMRA Board of Directors in 2013 to serve as Editor-in-Chief of EM Resident Magazine.
Nathaniel Mann, MD

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