As I am rounding the corner of my final year of medical school, I finally found some time to read the 1978 classic, House of God, by Samuel Shem. For those of you who don't know, this medical satire follows a group of young interns as they embark on their first years of residency. What struck me most about this book was not the uncomfortable nature of its aggressive humour (most of which has not aged particularly well), but the degree to which it still rings true today. Despite recent curriculum initiatives and a widespread push-back against the toxic 'has been' shame-based culture of medical learning, the harsh reality is that we are still a long way away from the ideal of a healthy, non-hierarchical, wellness-centred culture.
Early on in medical school, I read a book that would profoundly impact the way I thought for years to come: The Gifts of Imperfection, by social worker and PhD researcher Brené Brown. While I always knew I was a perfectionist, I had been under the impression that this was a good thing. After all, had perfectionism not been the driving force behind many of my academic and athletic accomplishments -- the very things in my life for which I had received the most praise? It had been, but not for the reasons I originally thought. What I failed to realize until recently was that this inherent perfectionism had a lot less to do with my own desire for self-improvement, and much more to do with the addiction to the external validation that came along with it. Without knowing it, I had allowed my self-worth to become something that was dictated by others based on what I was able to do, rather than something intrinsically known based on who I was and what I stood for.
Perhaps the most uncomfortable and shocking thing of all is the (largely) unspoken driver of perfectionism itself, which for many lies totally beneath their conscious awareness: shame. At its core, what drives so many of us to get everything exactly right every time (to the point of driving ourselves into the ground) is not the natural drive to learn, but the shame that comes with being wrong. I know what you're thinking, and I agree -- this is exactly the opposite of what we need in order to truly foster a culture of healthy learning. By putting perfection on a pedestal in an attempt to bring out the best in medical learners, we paradoxically quash the very thing which promotes their growth.
In her new book, Atlas of the Heart, Brené nails the proverbial nail on the head when she says this:
"We have learned that achieving mastery requires curiosity and viewing mistakes and failures as opportunities for learning. Perfectionism kills curiosity by telling us that we have to know everything or we risk looking 'less than'. Perfectionism tells us that our mistakes and failures are personal defects, so we either avoid trying new things or we barely recover every time we inevitably fall short."
Now, I will be the first to tell you I have made many mistakes along my journey. What has changed, however, is the way I look at them. Rather than to say I am stupid after saying or doing something I later came to regret, I am now much more likely to say I did a really stupid thing. When I separate myself and who I am from the behaviour and what I have done, it helps to keeps the impending shame spiral at bay. I know it is hard to imagine, but someone can be both intelligent at their core and also have done a stupid thing. We need to step away from the destructive culture in which someone must be either this or that, and lean into the dialectic truth that someone can be this and that.
To put the shame to bed once and for all, after any type of identity-jolting event, I will call up either a friend or my partner, tears rolling down my face, to explain to them what had happened. And again, Brené Brown has opened my eyes as to why this is so essential:
"In a world where perfectionism, pleasing, and proving are used as armour to protect our egos and our feelings, it takes a lot of courage to show up and be all in when we can't control the outcome. It also takes discipline and self-awareness to understand what to share and with whom. Vulnerability is not oversharing, it's sharing with people who have earned the right to hear our stories."
Your imperfections are not some dirty secret -- they are a part of what makes you human.
I will finish by saying that I have been lucky to have many preceptors over the years who have modelled exactly this type courageous and vulnerable leadership that I myself hope to embody when my time comes. These individuals are the type of teachers who remind you why you came into medicine in the first place. They inspire you not to be perfect, but to be your absolute best.
Unfortunately, the misogynistic and racist culture that has existed in medicine for 100s of years will not (and has not) change overnight. We must fundamentally change the way we think about educating the next generation, and be intentional so as to do it in such a way that not only encourages vulnerability, but requires us all to leave our perfectionism at the door.