Part 2 of Getting Unstuck from Procrastination - how procrastination and perfectionism are related

Last week we discussed procrastination and knowing if you are ready to change the pattern. 

This week and next, we will take a look at common themes driving procrastination. 

For many physicians, a pervasive one is unhealthy perfectionism.  When we strive for a perceived external bar beyond realistic human competence, it triggers a cascade. When we think things like, "This has to be perfect," it can lead to an emotion of pressure which will lead to wanting to delay getting started.  Or when we think, "There is so much to do for this to be perfect," it leads to feelings of overwhelm, which leads to putting off the tasks as they seem too numerous. I won’t belabor the point. But pause for a second and reflect on what you’re telling yourself about the task. When you realize what you are telling yourself, how does narrative make you feel? When you feel that way, how does it relate to procrastination?

Let's deconstruct unhealthy perfectionism.  I like to contrast it with a healthy perfectionism or a healthy striving for excellence.  Dr. Jennifer Hunt uses the illustration of a light switch vs. a rheostat.  Instead of perfectionism being on and you're perfect, or it’s off, and you're mediocre, learn to see perfectionism as something you can dial up and down depending on the task at hand. You’ve likely heard the phrase, “It’s okay to do B-minus work.”

Now immediately, many of you are squirming. There is fear behind giving up unhealthy perfection. Let’s look at why. What would happen if your clinic note was graded as a B instead of an A+ with extra-credit. A B quality note is one that you or a colleague can read in the future, and you know what took place and what the plan was. A biller can look at it and see the complexity documented to support the billing. A lawyer can look at it and can follow it. What does A+ give you or your patient? Likely, a lot of pressure, added time, dread of completing the note, and not much else. Maybe it gives you a sense of pride? If that’s true, does that sense of pride outweigh the amount of time you spend outside work hours on documentation? Does it outweigh the time lost with family, friends, and self-care? Does it outweigh the increasing stacks of inbox tasks?  Look at your reasons, consider testing out a couple of B-quality notes, and see what you think. 

What drives the need for unrealistic perfection? Often, it is fear. Fear of missing the mark – and what you make that miss mean about yourself. Fear of what others will think. Fear of outright failure.

Let's take a minute to look at those a bit more in-depth.

Let’s say you’re suturing a laceration. One suture doesn’t line up perfectly with the others – missing the mark, sort of speak. Do you make that mean you’re unskilled, a screw-up, a slow-learner, etc.? Can you realize that either it’s off enough you rethrow that stitch, or it’s not going to affect the healing, so you leave it alone and know it is good enough? Can you enjoy the fact that the more sutures you place, the better you will get? Can you enjoy mastering the craft while losing negative self-talk and unnecessary suffering? 

Let's say you're a resident, and you know you will be evaluated on your presentation. When your attending offers constructive feedback on your presentation, are you inside your head wondering what they are thinking of you because you didn’t do it perfectly? What if you could see they want you to continue to grow and improve? Attendings often look for areas to help you become your best self. When they have nothing to offer, does that mean you have no room to grow? Don't fear what others are thinking. Those that are for you are only thinking of your growth. People that aren't for you can be wrong about you - no need for unnecessary suffering. Your worth is not in other's opinions of you. Read that again.

Who defines failure? As an attending giving a lecture, do you define failure as no one asking any questions? Or too many people with unanswered questions? Or a resident nodding off? So often, the narratives we create in our heads are baseless and wrong. When we are afraid of failing, our brains are on full alert and will make almost anything mean failure. You can look at each of those observations above and find alternate explanations. What if you have objective evidence – the evaluations say your presentation is "too much crammed into one talk," "too long," and "slides too busy" – you can either wallow in self-pity and make it mean you've failed or learn from it. Pick out key points, lessen busyness on the slide, and end on time. Also, I'd like to point out that you can find wins even with those evaluations if you look. You can think, “I over-delivered.” And focus on the fact none said, "I didn't learn a thing." You gave a presentation, and they learned. I say you can even define that as a win! 

In summary, look to see how you’re using perfectionism for yourself or against yourself. Can you put it on a dial? Can you define failure for yourself, give up creating narratives of others’ thoughts? Reframe feedback? Once you do those things and choose courage in the face of fear, getting tasks done seems a bit more doable.  

Next week, we will look at other common drivers and solutions.  

Have a Joy-filled day!  Tonya

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