Perfectionism in professions where mistakes are not allowed

“I know everything was fine. But what if I didn’t check it one more time?”

It is almost midnight. The on-call shift ended three hours ago; the results were reviewed, the decisions written down. And yet the thought keeps returning to one patient, to one number on a lab report that sat right on the borderline. Elsewhere, a lawyer is reading a contract for the third time, although the client has already signed it, looking for a comma that might change the meaning of a clause. In another tower, at two in the morning, an analyst checks a formula in a financial model once more, because he is afraid someone will find, in the morning, a mistake he overlooked.

These three people do not know each other. They work in completely different worlds. But they have something in common: they work in professions where a mistake is not merely unpleasant, but can cost someone their health, their freedom or a great deal of money. And all three learned — probably very early on — that the only safe path is for there to be no mistake at all.

In this post I want to write about perfectionism in exactly these professions: among doctors, lawyers and investment bankers. I am interested in the point where the high standards these jobs rightly demand spill over into something that slowly wears a person down. And in what you can do about it without giving up what makes you good at what you do.

Two kinds of perfectionism you cannot tell apart from the outside

As early as 1978, the psychologist Don Hamachek proposed a distinction that researchers still use today. The “normal” perfectionist sets high goals and enjoys reaching them, but knows how to ease off when circumstances do not allow for more. The “neurotic” perfectionist, on the other hand, never feels that he has done well enough. Success brings him no satisfaction, only a brief respite before the next threat.

Later, research groups around Randy Frost and around Paul Hewitt and Gordon Flett set out to measure this more precisely. Today we speak of two dimensions. The first is perfectionistic strivings: high personal standards, the wish to do your work excellently. The second is perfectionistic concerns: fear of making mistakes, doubts about your own actions, the feeling that others are judging you and that their acceptance depends on you being flawless. You will also find a short explanation of the concept in the knowledge base under perfectionism.

The difficulty is that both dimensions look the same from the outside. A surgeon who wants a perfect suture and a surgeon who wakes at night terrified that the suture will not hold are doing the same thing outwardly. The difference lies in what is going on inside them — and in how much it costs them.

Why these professions in particular

It is no coincidence that medicine, law and finance are full of perfectionists. These professions do not only shape people; they also select them. You do not reach a specialist training post, a partnership in a law firm or a place in an investment bank without years of being better than everyone else. Selection rewards people who, already as pupils, read everything on the list and a little more.

In 1985, the American psychiatrist Glen Gabbard published an article with the telling title The role of compulsiveness in the normal physician, describing what he called the compulsive triad: doubt, feelings of guilt and an exaggerated sense of responsibility. His point was not that doctors are ill. Quite the opposite: these traits are useful in medicine. A doctor who doubts will check once more. A doctor who feels responsible will not leave a patient in the corridor. But the same triad that makes a good doctor can wear him down outside the surgery — because it does not switch off when he goes home.

Something similar applies to law. Martin Seligman, one of the founders of positive psychology, pointed out an unusual paradox in his book Authentic Happiness: for lawyers, pessimism — the ability to foresee everything that could go wrong — is a professional advantage. A good lawyer sees a trap in every clause. Yet the same habit, carried into private life, means that in your partner, your children and yourself you see mostly what could go wrong.

In investment banking the story is different again. Here a mistake in a single assumed percentage changes a valuation by millions. The hours are long, decisions fast, reviews by superiors merciless. The anthropologist Alexandra Michel followed young bankers in two banks for nine years. She described how they initially treated their bodies as a tool to be subordinated to the work — and how, after a few years, for many of them that body began to give way: through illness, insomnia, injuries. What looked like unshakeable dedication had a price that only became visible later.

Perfectionism is on the rise

If you feel that the pressure today is greater than it was twenty years ago, you are not alone. In 2019, Thomas Curran and Andrew Hill published a meta-analysis comparing the scores of students from the United States, Canada and the United Kingdom between 1989 and 2016. The biggest increase was in so-called socially prescribed perfectionism — the belief that others expect perfection from you — which rose by roughly 33 per cent.

This matters because it is precisely this kind of perfectionism that is most closely linked to anxiety, depression and burnout. So it is not only about setting yourself goals that are too high. It is about the feeling that the world is constantly judging you and that every slip of yours is visible. The young doctors, trainee lawyers and analysts entering their professions today grew up in this climate — and are now entering environments that intensify it further.

A culture that cannot tolerate mistakes

Perfectionism is not only a personal trait. It is also a trait of organisations. In some hospital wards, law firms and banks, mistakes are not talked about, or they are talked about with irony and ridicule. Young people learn that it is better to hide something than to admit it. Older colleagues who survived the same system unconsciously pass it on: “That’s how I was taught, and I survived.”

And so a cycle forms. A culture that punishes mistakes with shame produces people who fear mistakes. People who fear mistakes hide them. Hidden mistakes are repeated, because nobody learns from them. And every repeated mistake proves that the strictness was justified. This mechanism is especially painful in medicine, where a mistake can mean harm to a patient — I write about what happens to a doctor after a complication in the post After an error: the doctor as the “second victim”.

The point is not that medicine or law should become more “relaxed”. It is the difference between a culture that treats a mistake as information and a culture that treats it as proof of personal worthlessness. The first makes people more precise. The second makes them more frightened — and a frightened person does not think more clearly.

What perfectionism does to the body and to relationships

In a 2016 meta-analysis, Andrew Hill and Thomas Curran summarised the research on perfectionism and burnout. Perfectionistic concerns — the fear of making mistakes, the feeling that it is never enough — were clearly and consistently linked to burnout. For perfectionistic strivings the picture was more mixed: in places they were associated with greater engagement, but the protection they offer is weak once fear joins them. If you recognise yourself in an exhaustion that does not lift even after a holiday, you may find the post Burnout is not laziness: signs your nervous system is asking for a break helpful.

In the therapy room this looks very concrete. Someone comes because of insomnia, because at night their thoughts circle around the day. Or because of tension in the jaw and shoulders. Or because their partner asks when they last talked about anything other than work. Perfectionism does not stay at the office. If you have spent the whole day vigilantly making sure you do not make a mistake, it is hard to switch over at home. Children get corrections instead of praise. A partner gets analysis instead of closeness. And the harshest criticism goes to the person himself, from the voice I describe in more detail in the post The inner critic: where the voice that constantly judges you comes from.

I notice something else, too. People in these professions often attribute their success to their fear. “If I weren’t so hard on myself, I would have done something wrong long ago.” That is why they do not want to give up perfectionism — it feels like a safety net without which they would fall. This feeling is understandable. But it is often not true. Precision and fear are two different things, even if in us they have grown together.

Where it comes from: a look into the family

In relational family therapy, in which I am training, we are interested in how a person learned that they are loved. For many perfectionists the answer is painfully simple: they were loved when they succeeded. Not necessarily because their parents were cold. Sometimes the parents were frightened themselves — for survival, for their reputation, for what others would say. The child sensed that a top mark calmed the parents and an average one unsettled them. And learned to look after them by being flawless.

Christian Gostečnik describes how such patterns are passed down the generations and how, as adults, we unconsciously recreate them — at work as well. A strict head of department or a demanding partner at the firm can awaken in us the same old tension we once felt as our father looked over our school report. That is why the reaction is often out of proportion to the situation. It is not only about this lab result or this contract. It is about the question of whether you are still enough.

If you are curious about how the pressure to succeed took shape across the generations of your family, this can be the starting point for a longer genogram session, A Look into the Past. In it we draw your family tree together and look at where the demands for perfection appear — and where they may have begun.

A conversation that comes back in many versions

This is how a conversation on this theme might sound, one I hear in different forms (composite, not a real person):

“I don’t understand why I can’t stop. I know it’s good enough.”
“What would happen if you sent the contract today, without one more read-through?”
“Probably nothing. But if something did happen, I’d be the one who failed.”
“And what would that mean about you?”
“That I’m not as good as everyone thinks. That I’ve just been lucky until now.”

The last sentence holds the core. The fear is not so much a fear of making a mistake as a fear of being exposed — of others seeing what the person secretly believes about themselves. This feeling is also known as impostor syndrome, and it is surprisingly common among successful professionals. Behind it there is usually shame: the feeling that something is wrong with me, not only with my work. I write about how profession and shame become intertwined in the post When your profession becomes your identity: the shame that cannot be admitted.

An exercise for today: two kinds of tasks

This exercise does not ask you to give up precision. It only asks you to direct it to where it is genuinely needed.

1. Write down every task waiting for you today. Without ranking them — everything, from an important meeting to replying to an email.
2. For each one, ask yourself: what realistically happens if it is done to 80 per cent? If the answer is “someone could be seriously harmed”, mark it with the letter A. If the answer is “something will be less elegant” or “someone might notice a small error”, mark it with B.
3. Choose one B task and deliberately do it “well enough”. Send the email without a third read. Leave a sentence you could still improve.
4. Notice what happens in your body. Where do you feel the unease? How long does it last? Do not try to chase it away; just observe it, and after ten minutes rate it on a scale from 0 to 10.
5. In the evening, write down what actually happened. Not what could have happened, but what did. Compare it with the prediction your fear gave you.

Most people discover two things. First, the unease was strong, but it passed more quickly than they expected. Second, the consequences were much smaller than predicted — often there were none at all. When you repeat this a few times, the fear begins to learn to tell A from B. Self-compassion can help you here too — not as indulgence, but as a different way of talking to yourself when something does not go well.

Where this explanation does not apply

I want to be fair to the other side, too. Some things in these professions must be flawless. The dose of a medicine, the deadline for lodging an appeal, the account number on a funds transfer. These are not about perfectionism but about professional responsibility. Nobody wants a surgeon who has decided that 80 per cent is enough. The aim is not for you to become careless, but for precision to stop being your only protection against shame.

Likewise, not all tiredness is perfectionism. If you work in a system that is short of people, where you have twice as many patients or case files as can be handled responsibly, then your exhaustion is not a personal failing. It is a reasonable response to unreasonable conditions. In that case therapy can help you not to carry it alone and not to blame yourself, but it cannot replace a change in how the work is organised.

And finally: researchers still do not agree on whether “healthy” perfectionism is even the right term. Joachim Stoeber and Kathleen Otto argue that strivings without concerns can be adaptive. Others, including Hill and Curran, warn that even strivings do not protect against burnout as well as we might wish. My view is simple: the more fear there is in your perfectionism, the less it serves you.

If your perfectionism comes with intrusive thoughts and checking rituals that take hours of your day, or if you have been without energy and hope for a long time, it is right to see your GP or a psychiatrist first. If you ever think it would be better if you were not here, call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (every day from 7 pm to 7 am) or the Samaritans helpline Samarijan on 116 123 in Slovenia (24 hours a day). In an emergency, call 112.

How therapy can help

In therapy we will not be getting rid of your standards. Together we will explore where the fear of making mistakes first appeared, how it helped you survive back then and where it harms you today. People in demanding professions often come to therapy feeling that they ought to solve this on their own — which, let us admit it, is also a perfectionistic belief. You can read more about how perfectionism and constant overthinking are connected in the post Perfectionism and overthinking: two sides of the same fear.

The therapeutic relationship is one of the few places where you do not have to be good. Where you are allowed to say that you are tired, that you are afraid, that you are not sure. For people who have built their whole lives on being flawless, this can feel very strange at first — and that is exactly why it matters. I also work with English-speaking clients, in person in Ljubljana.

What to remember

• Perfectionism has two dimensions: high standards and fear of making mistakes. It is mainly the second that is consistently linked to burnout.
• Medicine, law and finance select people with perfectionistic traits and then reinforce those traits.
• Socially prescribed perfectionism rose by roughly a third between 1989 and 2016.
• Success you credit to fear feeds the cycle of perfectionism; success you credit to knowledge loosens it.
• Precision is a professional responsibility. Fear of shame is not a precondition for it.