Perfect Mediocrity

May 17, 2013
Eric Postal, MD

We strive for perfect, even as things don't perform as intended. This gets harder with the push for greater efficiency. One solution? Accept the imperfections.

A friend of mine recalls a late childhood experience, going holiday shopping with his parents. Always on the lookout for a bargain, his parents got an oversized, discounted bag of "seconds," that is, assorted candies which had turned out less than perfectly: fragmented, incompletely wrapped, etc. Upon discovering their flawed loot, his brother commented, "Man, I hate this Soviet stuff."

That sentiment summed up much of our upbringing, even if we didn't recognize it at the time. Though we weren't exactly destitute, our homes were full of things that weren't…shall we say, flawless. A three-way lamp for the nightstand might only function in two modes. A toaster might not automatically pop up. A toilet-handle might need jiggling after each use.

Such things were far from miseries. One incorporated workarounds for each flaw into routine behavior, to the point that one almost didn't notice them. Almost. They did tend to stand out more when company was over. And especially when one acquired a new item for the home, which worked perfectly - until it developed its own quirk, or at least got minor cosmetic damage. Then, it fit right in with everything else.

Having recognized this permeative pattern of imperfection, my friend and I started looking forward to the day when we, ourselves, would have our own homes, in which we would have things that looked flawless and worked perfectly as intended. After all, how much more could it really cost to buy quality, and replace things as they developed minor failures rather than waiting until all function was lost?

We certainly believed that, once we landed desirable jobs in good, competitive fields, such a minefield of flaws would not await us in the workplace. After all, a business needs every edge to survive, let alone prosper over rivals.

Reality has not quite lived up to such expectation. We continue to find ourselves surrounded by items, processes, and even humans that don't - quite - work as well as they should. And, perhaps because neither of us has wound up at the top of our respective organizations' chains of command, we don't seem to have the power to do anything about it.

Our inherent sense that things should perform as intended remains intact, however, and we therefore strive for perfection in the limited sphere of influence over which we exercise control. We are extremely vigilant for ways in which we can improve our performance, and when we identify an external factor which impairs us, we can't help but look for ways to rectify the situation -getting variably frustrated when the solutions are plain to us, but we are not permitted to implement them.

This effect gets multiplied with the never ending march towards greater speed and efficiency.

For instance, suppose I'm dealing with a flaw in my software which forces me to shut down and restart my PACS on the average of every tenth case I read, taking two minutes before I can get back to work (let's pretend the disruption to my concentration has no additional impact).

Years ago, when I was on a flat salary and reading about 50 cases a day, that would mean 10 wasted minutes in a shift. Irksome, but I was getting paid either way and the guys signing my checks could fix the issue if/when it mattered to them.

Nowadays, reading over 100 cases per shift with compensation tied to my productivity, I'll lose over an hour per week from the same little flaw, and it'll have me seeing red every time it happens.

One way of adapting (perhaps the only way to avoid long-term harmful effects to one's cardiovascular and gastrointestinal systems) is to shrug and accept that one is never getting away from mediocrity. Doesn't matter if one clearly sees a dozen easy, free ways to exponentially improve things; the powers that be aren't listening or just don't care, so I won't either.

With apologies to the old Soviet joke: They pretend to give us high-quality tools and an efficient environment, and we pretend to make good use of them.

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