Perfectionism, Procrastination, and Fear of Failure

An earlier version of this article originally appeared on Doximity.com in December 2022, where I served as an Op-Med Fellow from 2022-2023.

You probably didn’t become a physician without a healthy dose of perfectionism. From preschool through residency and beyond, many of us have survived, thrived, and been rewarded for our perfectionist tendencies. And when you didn’t hit the mark? You may have felt the sting of your parents’ and teachers’ disappointment. Eventually, you may have learned to define yourself by your perfectionism.

Perfectionism seems to be on the rise, especially among people born in the 1980s and later. Those on the outside may mean well when they assure us that perfectionism is an impossible goal, but the truth is that perfectionism is a prized attribute in our profession. Our patients appreciate it as well. After all, who wants a doctor who is willing to just scrape by?

Paradoxically, perfectionism can keep you from doing your best work. It can also hold you back from living your best life. In this article, I’ll talk about how perfectionism and self criticism often go hand in hand with procrastination. And I’ll give you a few actionable steps that can help you to overcome the self-imposed inertia that perfectionism often creates.

Perfectionism, Procrastination, and Imposter Syndrome

It’s not surprising that perfectionists often suffer from impostor syndrome. If you’re a perfectionist, you may fear that you are simply not good enough and that you will eventually be exposed for all to see. And in fearing that you are not going to meet the high standards you set for yourself, you may subconsciously find ways to procrastinate as a means of avoiding that discomfort.

When you fall prey to imposter syndrome, you may overlook or give up opportunities for growth that could lead you to a more rewarding and exciting professional path. Learning new skills, taking on a leadership role, and discovering a position that is more aligned with your values may all fall by the wayside.

And when you’re uncomfortable with embracing a beginner’s mindset, you may find yourself reluctant to take up hobbies or endeavors that might enrich your life and create new connections.

Perfectionism, Procrastination, and Fear of Success

Another factor holding perfectionist physicians back is, perhaps counter-intuitively, a fear of success. This often arises from fear of change and the unknown. The end result may be the same: procrastination and a failure to act in your own best interests.

Fear of failing to meet your highest standards often manifests in such mundane activities as uncompleted charts, unanswered messages, and unopened emails. This compounds the problem, and can create enormous stress, not to mention nasty messages from administration.

Breaking the Cycle of Procrastination

If you’re having a hard time getting started on a task, big or small, don’t beat yourself up. Chastising yourself for feeling overwhelmed and disorganized may only make the procrastination problem worse by confirming your fear of inadequacy and filling you with anxiety. And thus, the problem comes full circle.

To break the cycle of fear, frustration, and despair, it’s important to recognize that procrastination does not mean that you are incapable or irresponsible. And let’s establish right now that as a busy and caring physician, you are certainly not lazy.

So how can you harness your perfectionism? The key is to focus that superpower on providing excellent patient care. Sometimes that also means treatment plans, operative notes and imaging reports. These are things that truly make a difference, and that people are depending on you to complete. They don’t have to be works of art, but they need to be complete and correct.

Often it’s the non-clinical commitments, stacks of insurance paperwork, and lingering home projects that drain your mental energy. If no one’s life or livelihood depends on it being perfect, allow yourself a little grace. Realize that for many of your routine tasks, perfection is not worth the effort and may not even be possible. For many of these, good and done is good enough. Other times, it might be most efficient to simply delegate. And sometimes, when it’s appropriate, you just have to say no.

Below, I share some practical tips for tackling a handful of competing priorities and getting stuff done.

1. Medical documentation

We’ll address the elephant in the room first: your medical charts. As charts start to pile up and paperwork is left unfinished, your anxiety levels may rise, and you may find yourself in a spiral of regret and self-flagellation. If you have a system that works for you, kudos and keep it up.

But for the many physicians for whom the EHR and report generation are a major source of stress and procrastination anxiety, it’s important to get a handle on this beast as early as possible in your medical career. Just get the charts and notes done, either immediately during or after the visit (my preference) or at the end of the session.

The fewer times you have to return to a document, the more focused and efficient you will be.

Yes, the notes need to be succinct, truthful, and useful. And personally, I always found that including a brief personal observation reminded me of the issues that were meaningful to my patients when we met the next time. But your notes do not have to be perfectly crafted works of literature. Punctuation, spelling, even virtual voice transcription errors that don’t change the meaning of the sentence can often be safely overlooked.

Consider using “smart phrases” — text blocks that you use frequently that can be automated through your EHR system — as much as possible when appropriate. Look into using an AI assistant for history taking, if you can assure accuracy. The point is not to be sloppy or incomplete, but to include the pertinent details that assure great patient care and communication as efficiently as possible.

To avoid a horrendous backlog, create a block of time once or twice each day to get patient communication, testing review, insurance, and other paperwork done. This is known as task batching. Do it consistently every day (perhaps using the Pomodoro method), and even though you may not finish everything all at once, you’ll have a process for getting it done. Once you start seeing the results of your efforts, your feeling of self-efficacy will increase.

Let your staff know that you will be working on these tasks within these blocks of time. That way you can set expectations and encourage them to direct pertinent issues to you at a time that works best for you. Ultimately, this may create a clearer sense of work flow within the practice and enhance your teamwork.

2. Professional Commitments

When it comes to committees, research, and other professional commitments, take a good long look at what you’ve signed up for. Be sure that the work is meaningful and actionable for you.

Sometimes taking on more responsibilities is the right thing for your professional growth or your career trajectory. If so, it’s important to stay committed. Procrastinating on these commitments can have a seriously negative impact on your future opportunities.

Consider working with an accountability partner who is on the same committee or working on the same project. You can keep each other on task with quick check-ins by text. Simply committing to a plan can often get you halfway there.

But if you find that you just have a hard time saying no, then it’s time to reassess. As writer and time management guru Oliver Burkeman so aptly puts it, if we’re lucky, we only have Four Thousand Weeks. That means that time is a fixed resource. When you say yes to something, you are saying no to something else.

If your commitments exceed your capacity, you will never get everything done. Choose wisely. And remember that saying no doesn’t mean never or not at all. Is there a way to stay involved with something meaningful without diving all the way in?

3. Your Personal Life

Having a life outside of the clinic or hospital helps you to decompress, stretches your brain, and keeps you connected to the outside world. When it comes to family and close friends, your time and attention matter. And of course regular exercise is critical for just about every aspect of your health.

Unlike taking care of patients, the bar is fairly low. Usually no one is depending on you to be the best. Just being present and engaged is often enough. For your home projects, exercise, and other extracurriculars, consider using a Bullet Journal or other daily log.

Experiment with using a real notebook rather than an app. Not only does writing something down tend to create more solid memory retention, it’s easy for virtual to-do lists to disappear into the ether of the internet, never to be seen again. Most importantly, choose what works best for you, and be consistent.

To get started with something new, commit to just five to 10 minutes a few times a week, or set up an introductory lesson for something that interests you. You’ll be surprised how much you can do, and it may motivate you to keep going. If you’re not perfect, all the better. You’ll learn and grow and maybe even find new life passions.

Procrastination and Self Compassion

If you’re a chronic procrastinator, developing self-compassion is important. But being kind to yourself doesn’t mean you can ignore the pressing problems that procrastination has created. That will only add to your stress, and create more trouble in the long run.

When you put off completing charts or making calls, procrastinating can also hurt your patients and your practice. In the worst cases, medical care may be delayed and important notifications missed, with possibly serious ramifications for the people who depend on you.

If the load feels overwhelming, realize that procrastination-born perfectionism can lead to important mental health conditions including depression, anxiety, and eating disorders. Get help from a mental health professional if you need it. And if you are questioning your efforts, your direction, or experiencing burnout, consider meeting with a physician coach.

Remember: your perfectionism is one of your superpowers as a physician. You have high standards, you solve tough problems, and you keep people safe. Leverage this, cherish it, but don’t let it take you down the road of procrastination.

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Physician Stress and Burnout: How Mindful Coaching Can Help

Physician burnout is not a new phenomenon, but over the past several years, it has become a true epidemic. In 2021, 930 academic papers were published on the topic, compared to 129 in 2011. In 1984, the year I started medical school, a total of 4 articles can be found in the PubMed archives.

Today burnout is out in the open. But the tools to manage and prevent burnout remain elusive.

The term “burnout” itself may sound a little nebulous, but there are methods to measure and define it. The Maslach Burnout Inventory defines burnout as “a psychological syndrome” that “occurs among individuals who work with other people”, with symptoms including:

• Emotional exhaustion, feeling unable to give more of yourself

• Depersonalization, resulting in negative or cynical attitudes towards patients

• Reduced sense of personal accomplishment, meaning a tendency towards negativity towards your own accomplishment.

It’s important to understand that burnout is not a psychiatric disorder, but rather it is “ a normal response to a chaotic and stressful environment”.

Many of us have experienced these feelings from time to time, and that’s completely normal. But when these feelings are persistent and overwhelming, then it’s likely that you’re dealing with burnout.

In a 2022 survey, Medscape found that 47% of physicians reported burnout, up from 42% in 2021. Not surprisingly, Emergency Medicine and Critical Care reported the greatest burnout (60% and 56% respectively), but Ob-Gyn (53%), Infectious Disease (51%) and Family Medicine (51%) were close behind.

Women reported more burnout (51%), perhaps due to competing responsibilities at home which were aggravated by the pandemic. But more than a third of men were also affected.

The contributors to burnout reported in the survey are not surprising to anyone in healthcare. Topping the list:

• Bureaucratic tasks

• Lack of respect

• Long hours

• Lack of autonomy

These features are nearly identical to the six factors associated with workplace stress that were identified by the British workplace health and safety regulatory agency:

• High work demands

• Low control over workload and process

• Inadequate support from management and colleagues

• Poor workplace relationships

• Lack of clarity regarding professional role and responsibilities

• Poor management of change within the organization

Beyond making you miserable, stress and burnout affect your quality of life, your self-confidence, your relationships at work and at home, and perhaps even your patient care.

Sometimes it feels as if everyone is talking about stress and burnout, but nothing is being done about it.

Although mindfulness has been shown to be effective in mitigating the symptoms of stress and burnout, it feels disingenuous to tell physicians to get a grip by practicing yoga and meditating.

Clearly, we are not going to yoga our way out of this mess. And hospitals and healthcare systems need to do more than offer lip service. But in the meantime, a little mindfulness may help. Here’s how:

First let’s start with a simple definition of mindfulness. As a certified Mindfulness Meditation Teacher, I’ve been fortunate to learn from Sean Fargo, a former Buddhist monk and gifted teacher. Sean defines mindfulness as “paying attention to the present moment with curiosity and non-judgment”. In other words, simply being present.

This sounds nice, but how can it possibly help you overcome the powerful forces that lead to stress and burnout?

As it turns out, there have been a number of studies in recent years that were designed to answer just this question. A meta-analysis of six high quality randomized controlled studies of mindfulness interventions for medical students, published in 2020, reported substantially lower stress indices in students who participated in the programs.

These programs incorporated interventions that included

• Body scanning

• Awareness of thoughts and emotions

• Breathing exercise

• Walking meditation

• Sitting meditation

• Coping with stress

Most programs were once weekly group sessions, while one used a mobile app.

Not only did stress scores improve in the short term, compared to controls, but studies that reported six-month follow-ups found that the benefits of mindfulness teaching persisted.

Coaching is another effective strategy for physicians at all stages of professional life. Although it is no substitute for system-wide change and mitigation of the issues that lead to burnout in the first place, coaching can help physicians gain traction and make decisions that help them to reclaim their connection to the profession.

That can range from important changes that create a better work-life balance in the current setting to a move to a new position or workplace. In some cases, a coach may work with a physician who decides to leave the profession altogether.

Research supports the role of coaching as a powerful tool for physicians at all stages. A small study from Duke University included primary and specialty care physicians ranging from first year residents to more senior physicians with leadership roles. The program focused on coaching for physician well-being, and reported improvements in coping strategies, resilience and stress.

Regardless of the specific modality or focus, physician coaching as an intervention has clearly been linked to improvement in well-being and resilience. A 2019 randomized controlled trial of primary care physicians in the Mayo Clinic system looked at the effects of 6 telephone coaching sessions on

• Burnout

• Quality of life

• Resilience

• Job satisfaction

• Engagement

• Meaning at work  

After 6 professional coaching sessions by credentialed coaches, the rate of burnout decreased by over 17% in the coached group but increased by nearly 5% in the control group. And absolute rates of emotional exhaustion dropped by nearly 20% in the coached physicians but increased about 10% in controls.

Coaching is a powerful tool. Mindful coaching may help physicians manage and overcome the effects of the sometimes-overwhelming forces that impact them and, indirectly, their patients on a daily basis.

But most importantly, addressing and repairing the underlying sources of burnout and stress is paramount. This is a commitment that needs to come from the highest levels of our healthcare systems.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Berg, S. (2021). Q&A: Clearing up confusion on physician burnout and depression. American Medical Association

Christensen, A. J. et al. (2023). Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Military medicine, 189(Suppl 1), 64–70. https://doi.org/10.1093/milmed/usad277

Drybye, L.N. et al. (2019). Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. Journal of the American Medical Association Internal Medicine

Garcia, C. L. et al. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina

Hathaisaard, C. et al. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: a systematic review and meta-analysis. Asian Journal of Psychiatry

Health and Safety Executive. (2019). Tackling work-related stress using the management standards approach

Kane, L. (2022). Physician burnout and depression report 2022: stress, anxiety, and anger. Medscape

Maslach, C. et al. (1997). The Maslach Burnout Inventory Manual

Schneider, S. et al. (2014). Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore