My Harshest Critic

February 22, 2018
Eric Postal, MD

Seeking perfection requires examining past shortcomings.

I’ve got a pretty good memory. A downright painful one, sometimes, since it seems particularly attuned to things I’ve done less-than-perfectly in the past. I’m able to mentally replay any number of embarrassing moments dating back to my earliest years. Sometimes, that even includes incidents that I didn’t recognize at the time. In retrospect, I’ll suddenly realize that my side of a conversation I had, however-long before, must have seemed incredibly dumb, rude, insensitive, etc.

Unsurprisingly, the time I’ve spent as a physician-radiological and otherwise-has been no exception. I can remember any number of rookie blunders I made early on. Fortunately, the minority being clinical, since a fledgling doc has plenty of oversight from senior residents, fellows, attendings, etc. Still, there were plenty of errors in protocol, diplomacy, and simply finesse to make up the difference.
As I move along in my post-fellowship career (without the safety-net of senior housestaff), an ever-increasing volume of clinical work has amassed in my wake. Being that I’ve sadly not yet achieved perfection in this life, there continues to be a small fraction of this work that I subsequently recall with embarrassment.

Some are cases that went to QA, which I then recognized as having been “misses” on my part. Then, there were QA cases that I felt I read properly, but could have avoided allegations of error if I’d phrased myself differently such that there would have been no room for a “gotcha” on the part of whoever tried to ding me in the QA system. There have been procedural snafus where I got caught in what seemed to be no-win situations, and later realized means by which I could have finessed my way out of the mess.

There have also been cases where I finally found out what a particular imaging finding was (hepatic changes from long-term peritoneal dialysis being my personal favorite), and kicked myself for not having figured it out on half a dozen similar cases earlier in my career.
The sting of such recollections is that I tend to imagine my current self, with whatever wisdom I’ve gained, in my younger, less-experienced shoes. Behavior that might have been my best-possible effort back then, falls substantially short of what I imagine myself to be capable of now-hindsight being 20-20 as the saying goes. So I hold my younger self up to the standards of present-day … sort of like expecting someone in their earliest stage of marathon-training to do as well as they will on race-day.

The flip-side of this is that barring some unexpected foreshortening of my career, I might at some point down the line be regarding the work I do today as amateurish. Or, perhaps by then I’ll have become a less-harsh critic with myself than I have been to date. Maybe I’ll even be embarrassed at how unforgiving I used to be with my own efforts.

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