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Practice doesn't make perfect

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A VETERINARY student recently sought my advice regarding an academic crisis. The student, a high academic achiever like most veterinary undergraduates, was completing an honours research project, but progress had been delayed due to a bout of depression. With several months of treatment, he overcame his depression, but had lost time that would otherwise have been devoted to the project.

The deadline for thesis submission had been extended slightly, but he doubted whether it was worth handing it in at all. In his view, the chances of producing work to his normal standard were low as it would be rushed. This rendered the possibility of first-class honours somewhat remote, and he believed that honours was only worth doing if one was to be awarded first-class. Also, he felt he did not deserve an extension.

On the other hand, the only remaining task was to complete the thesis. He had collected all of his data and completed a literature review. Best intentions aside, many students write up at the last minute. His peers were likely to be in the same position.

To me this student's dilemma points to the crux of the problem with our profession; it reflects an all-or-nothing or perfectionist stance. That is, the belief that if you cannot do something perfectly, it's better to give up, withdraw and invest resources into those tasks which we know we can perform at a high level.

This attitude is incompatible with practice. Consider the humble bitch spay. I remember as a new graduate an incident during which, while fervently and over-zealously searching for an elusive uterine horn, I collected the spleen instead and promptly tore it with a spay hook. The defect began to haemorrhage, the dog's abdomen welled with blood like the hotel corridor in the opening credits of ‘The Shining’ and among my thoughts was the idea that perhaps I should just euthanase the dog so it would not bleed to death. In my mind, the error proved that I was not a good vet, but euthanasia would solve the immediate problem for all concerned very quickly and the animal would not suffer as a result of this mistake.

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Of course I didn't euthanase the dog. My hands were shaking so much that I had to scrub out while a colleague jumped in and sutured the splenic wound closed. The dog made a complete recovery.

The point is that the all-or-nothing approach is maladaptive. How often do we make a definitive diagnosis or base a treatment plan on a complete and comprehensive clinical picture? How many days do you clock-off thinking, ‘Every consult, every procedure, every interaction with clients and staff went perfectly today’?

We are professionally obliged to do our best, but when we err or circumstances intervene, we can't walk away, nor can we beat ourselves up every time the result is less-than-perfect. Yet plenty of us are perfectly miserable.

It can be hard to break the cycle. Studies have linked perfectionism with feelings of hopelessness, a negative cognitive bias and depression. Constant striving for perfection and failing can lead to stress and burnout.

The worst part of all of this is that we fail to recognise all the good we actually achieve. There is no simple antidote to perfectionism, but awareness of perfectionist tendencies is a good start.

The late physician and medical writer Lee Lipsenthal suggested we should replace the goal of being perfect with the goal of self-betterment: ‘If the goal is perfection, you can't win! My mentor in medical school taught me to ask, “what have I done today that I could do better tomorrow?” He never said “what could I do perfectly tomorrow?” Better can be good enough’ (Lipsenthal 2007).

If we really want to do something about stress and burnout in the profession, we need to train students on the perils of perfectionism.

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