Ben Hoban is a GP in Exeter.
Given the choice, it is hardly controversial to pick something good over something bad, something next-level over something merely adequate, or something perfect over something imperfect. Defining those terms can be more difficult, though, and necessarily depends on what we are looking for in a given situation. In general practice, the measure of a good decision is usually that it is a shared one, representing a reasonable balance of risks, benefits, and burdens. In this context, even the idea of perfection seems simplistic; it makes better sense to think in terms of doing something well than doing it right. How is it, then, that perfectionism thrives as it does among doctors?
Performance is framed in terms of conformity to best practice; not as the pursuit of excellence but as the avoidance of attributable failure.
The defining features of perfectionism are that we over-identify with our achievements and allow the indicators or metrics of those achievements to become goals in themselves.1 If we’re doing okay, we must be okay, and to make sure we’re doing okay, we generate data that show it clearly: a high Quality and Outcomes Framework score, good patient feedback, or a surgery that finishes on time. Perfectionism is strongly motivational and, on a good day, strongly rewarding. It is referred to at interview with a wink and a smile as a presentable weakness, although only in the same sense as a weakness for brightly coloured knitwear, giving the impression of both self-awareness and dedication to the job. It would be far riskier to describe oneself as an addict, although perhaps more honest.
The landscape of medicine inevitably promotes perfectionism. Medical school entrants are chosen on the basis of their academic and extra-curricular achievements; students are trained to pass assessments; residents are conditioned by praise and criticism; and GPs constantly run the gauntlet of complaints, inspections, and annual appraisals. Success, we learn, means saying and doing what we need to in order to pass the test. A few generations ago, medicine was largely impotent in the face of disease, while today, we assume that any illness can be treated, provided that one’s doctor follows the rules and doesn’t make any mistakes. Performance is framed in terms of conformity to best practice; not as the pursuit of excellence but as the avoidance of attributable failure. We know we are imperfect, but the need to present a perfect exterior leads to a constant inner tension. If we succeed in maintaining this tension, it is only as impostors waiting to be exposed,2 while failure is far worse, plunging us into what Sandy Miles refers to as “the dark pool of shame” that lies waiting for us beneath the tightrope. We have adopted as normative a cluster of values that come into their own in an operating theatre or major disaster, although they are less well suited to our everyday practice: clarity, certainty, and standardisation. They even define the aesthetics of modern healthcare, with its coloured uniforms that tell us who someone is and what they can and cannot do, bright lights reflected by gleaming metal, and smooth surfaces wiped free of unseen contaminants. We can capture these things in a single word: flawlessness.
Framed in these terms, the pursuit of perfection in general practice is understandable, although it is a doomed quest, unforgiving and exhausting. Those of us who recognise this generally take measures to protect ourselves, keeping work within clear boundaries and our souls wrapped securely in a drawer at home. Our response to the problem of perfectionism tends to be to aim lower, to consider what is good enough rather than what is ideal, and to find joy elsewhere. It is safer, but perhaps also less satisfying, and risks substituting one questionable ideal for another, that of the doctor who does their job and always leaves on time, who smiles at their patients but declines to cry with them. It also neglects a larger truth.
The things that set general practice apart from the operating theatre or major disaster are in fact entirely antithetical to perfectionism, including the need to accommodate ambiguity, uncertainty, and individuality. For us, perfection is not just an unachievable goal, but a false one, and perfectionism can never, even under ideal conditions, deliver the validation it promises us. The world of dazzling lights and polished surfaces is simply not the one we inhabit. Jun’ichirō Tanizaki writes about a different aesthetic which seems better suited to our consultations, one of shadows conveying depth and texture, and of gold leaf glinting in the half-dark of a room at twilight.3 It is the aesthetic of context and coherence, in which a flaw is seen not as an aberration or a sign of failure, but as a part of the whole with its own significance, the distinctive grain of something real that sets it apart from the bland conformity of that other world. Sometimes the light is too bright; we need the shadows to see things clearly.
A desire for perfection forces us to define too narrowly our goals and the methods we use to pursue them, and to side-line whatever falls outside this narrow view.
A desire for perfection forces us to define too narrowly our goals and the methods we use to pursue them, and to side-line whatever falls outside this narrow view. If we prefer to help our patients on their own terms and navigate successfully the landscape of our daily working lives, we will not usually find ourselves chasing more precision or control, but greater depth and understanding instead, shadows rather than brightness. Many of the problems we face in general practice cannot be fixed, and people cannot be perfected by doctors.4 There are perfect moments in every day, though, and they are generally defined by their humanity rather than their technical aspects. If we want what we do at work to reward the time and effort we invest in it, it makes sense to cultivate conditions which promote such moments and which help us recognise and engage with them when they present themselves, perhaps glinting like gold in the twilight. There may often only be one way to do it right, and many ways to fail, but there are more ways still to do it well.
References
1. Sandy Miles, Paradox of perfection: modern general practice and the impossibility of ‘Good Enough’ in neoliberal healthcare, Med Humanit 2026;0:1–5. doi:10.1136/medhum-2025-013533
2. Simon Tobin, Impostor syndrome in general practice: a cost of expert generalism, BJGP Life, 18th February 2026.
3. Jun’ichirō Tanizaki, In Praise of Shadows, first published 1933, English translation by Thomas J Harper and Edward G. Seidensticker, 1977, Vintage Classics edition, 2025
4. Charlotte Sidebotham, Good enough should be good enough, BJGP Life, 15th March 2026
Featured Photo by Afif Ramdhasuma on Unsplash
