The culture of perfection in medicine is a disease

I was always worried about doing well on board exams. I didn’t want to simply pass them; I wanted to excel. Before I took exams, rumor had it that a person would have to intentionally fail Step 1, 2, or 3 and that failing Step 2 CS was virtually impossible. The truth, I learned, is that thousands of physicians-to-be fail one of these exams every year.

I know, because I’m one of them.

I was on an away rotation when I received an email stating that my score report for Step 2 CS was ready. I almost didn’t open it, not because I was nervous but because I was sure I had passed. I had done well in medical school and was doing an elective at a prestigious Ivy League school. How could I possibly fail? Confident, I decided to check my score much later in the day.

And when I did: FAIL. I couldn’t believe it. How could this happen? I felt angry, scared, and really confused.

Ready to prove myself, I rescheduled the test for a week later. I flew across the country after a 24-hour shift to retake the exam. I was exhausted, but this time, I passed.

Reflecting now, I have been recovering for the last four years.

This may sound dramatic to those who are not health care professionals, but it is ingrained in us that these exams are the key to success. They are the keys to living where you want, specializing in your field of choice, and training at the institution of your dreams. That’s right, all those years of work come down to a couple of tests. So, when your performance is less than stellar, it feels like a lifetime of work and potential success crumbles.

The other piece is that “failure” is the Voldemort of medical training. The illusion of perfection is part of the hidden curriculum. We are expected to work up to eighty hours a week, excel in our studies, maintain exemplary physical and mental health, tend to our own families and loved ones, and care for patients, all while acting as if it’s easy. The truth is that being a doctor is actually quite extraordinary. Appreciating that can help you be more kind to yourself.

My advice to those of you who have “failed” at some point in medical training is to continue on. No one will ever remember your failures or your less-than-exceptional performance on an exam. They will remember how you held yourself when faced with adversity.

This point brings me to the greater, and more significant, truth: physicians are imperfect people. We are the physically and mentally ill, the regretful, the self-doubting, the shamed. And, we are the healers. Both are true. Both are important.

I ended up matching at Massachusetts General Hospital in psychiatry for residency, where I have excelled clinically and academically, and have been awarded for my strength in teaching. I think most of my colleagues would be surprised to learn about my failed exam. Although my shortcomings are plentiful, I strive to wake up and care for patients in the most authentic, informed way I can every day.

The culture of perfection, in my opinion, is a disease. It contributes to physician suicide, mental illness, burnout, and poor patient care. The way to treat it is simple: share your imperfections with those you trust. If you’ve made a mistake, do not hide it; apologize and continue on. If you need support, ask for it. Doctors can unite, not in our sham perfection, but in our genuine faults.

Andy Cruz is a psychiatrist. This article originally appeared in Doximity’s Op-(m)ed.

Image credit: Shutterstock.com

View 1 Comments >

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.