Anecdotally Speaking

The superfluous, a very necessary thing. --voltaire

Saturday, December 23, 2006

 

Perfection: The Unspoken Physician Performance Contract

Doctors have to be perfect. Everyone knows it. Patients know it and doctors know it. It is just that no one is allowed to say it in so many words or talk about it in that way. That is because we all know that it is an expectation that is not fair.

Unfair because doctors are human and humans cannot be perfect. Humans make mistakes and so doctors by default must make mistakes too. However, doctors are not allowed to make mistakes. They cannot make mistakes, must not make mistakes. They must be perfect.

Doctors are taught this in their training. If a young doctor makes a mistake, they are instructed to learn from their mistake so that they never make the same mistake again. They progress through their experiences to a place of having all of the mistakes worked out of them, a place where they can practice their perfection.

For the sake of humanity, for the sake of their patients, physicians agree to take on the impossible burden of perfection, at great personal sacrifice, in order to serve those that need them.

The pervasive expectation of perfection in medicine and the striving it engenders has led to phenomenal advances in the capabilities of health care, remarkable achievements.

It is ironic that the more successful medicine becomes in its quest at approaching perfection, the more intense becomes the demand for that perfection, and the more difficult it becomes to actually reach it. Feeding the beast only makes it hungrier, and the food becomes scarcer. It has been said that medicine's success has been its own undoing.

Voltaire warned, "The best is the enemy of the good." Sometimes good enough is just that, good enough. Since perfection is ultimately unattainable, its quest is ultimately fruitless. Seeking perfection tends to freeze us into inaction.

However, it is popular today to look at Voltaire's phrase turned around, as best selling author Stephen Covey, Ph.D. puts it, "The enemy of the 'best' is often the 'good.'" Another way of thinking about this is saying the adequate is the enemy of the excellent. Saying something is good means settling for something less than the best.

Medicine follows this way of thinking. Good doctors do not settle. They always go for the best. Their patients would not have it any other way and they would not have it any other way.

But what about when doctors mess up? Are they being only human or are they bad doctors? Or does that answer depend on how bad they mess up? Or does it depend on how often they mess up? Would it surprise us if we knew how many mistakes doctors really did make? Would we really want to know?

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