A surgery resident from halfway around the world emailed me the other day looking for advice as she was nearing graduation.  She confessed, “I am beginning to question myself if I am good enough … what is ‘good enough’ anyway?”

I had absolutely no idea how to answer the question – what is “good enough” for a surgeon?

First, I tried Google.

“Am … I … Good … Enough”?

2.5 billion hits and some good news!  All 2.5 billion of them confirmed that I am, in fact, “good enough.” All I needed to do was think it, live it, meditate, do yoga, and drink a lot of green juice and I’ll start believing it.

Phew.

Not convinced.  Google doesn’t know me – and it doesn’t know how hard my surgeries can be.

So, again: “Am I a good enough surgeon?” Just 1.4 billion hits this time.  One suggested that “good enough” for a surgeon meant “enough good traits and no ‘deal-breaking fatal flaws’.”  Another suggested that emotional intelligence, interpersonal connection, and respect provide the core of “good enough.”  As correct as this may be, it didn’t really help me or the surgery resident halfway around the world.  Like every surgeon I know, I swore an oath to do no harm to my patients. I respect my patients and colleagues, and I don’t think I’m riddled with fatal flaws.  Yet, this does not scratch the surface of a ‘good enough’ standard that I hold myself by as a surgeon.

When I was a martial artist nearly 20 years ago, I marched across the stage to the tune of Queen’s, “We Are the Champions.”  Someone put a gold medal around my neck, and for that brief glorious few seconds that I will never forget, the external world validated that I was best in the world at something.  All of my hard work, perseverance, resilience, and confidence led me to the point where I was lucky enough to have an official organization denote me as “good enough” in their eyes.  That surgery resident and I will probably wait our entire careers and never have anything come close to that in terms of external validation in surgery.

What I ended up saying to this resident halfway around the world was that I had built both of my careers in life (martial arts and surgery) to the simple goal of optimization – and this is something that I hold entirely internally for validation.  I fear perfectionism more than anything, but I strive for optimization.  Perfection, to me, is a fictitious endpoint – an endpoint that has paralyzed me and made me scared to show my limitations throughout training and practice.  I have actively combatted perfectionism my entire life.  But optimization is a process, not an endpoint.   Unlike perfectionism, optimization affords me the complete freedom to make mistakes – provided that I do everything possible to avoid making that same mistake again.  One of my chief residents scrubbed with me on two difficult, but nearly identical fracture cases over a two-week time period.  The first one was a struggle – and the second one went incredibly smoothly.  He exclaimed, “Wow, that one was so much easier!” at the end of the second case.  I first told him it was “magic” – and then I quickly corrected myself so that he could learn from the experience.  I explained how I sat at home after that first case and reviewed the intra-operative x-rays.  I forensically assessed my struggles, and added them to the optimization bank.  And, I vowed to do better and make things smoother the next time – hence the perceived “magic.”

What I told that surgery resident halfway around the world was that I couldn’t really help her define when she would know she was “good enough.”  Like “perfection,” “good enough” is not really for technical surgical skills.  If we ever stop struggling, adding to the “optimization bank,” and referencing the “optimization bank,” then it is time to move on and do something else in life.  As cliché as it may be, I told her to just be a little bit better tomorrow than she was today – and to try very hard not to repeat her mistakes.  Living by this simple but calculated, consistent, and focused process of optimization is how I will define the elusive “good enough” to the next person who asks.

Mara L. Schenker is an orthopedic surgeon.

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