Perfectionism in Orthopaedics

Research Type: Level 4 – Case series Introduction/Purpose: Perfection can be a goal within orthopedic surgery, but data suggests that being a perfectionist can be associated with depression and/or burnout. The purpose of this study was to determine if there was an association between being a perfectionist and depression and/or burnout. We hypothesized that being a perfectionist would be associated with increasing levels of depression and burnout. Methods: We performed a survey study of orthopaedic surgery residents and faculty. The survey collected demographic data and levels of perfectionism as measured by the validated Positive and Negative Perfectionism Scale (PANPS). The PANPS divides perfection into two types: positive, associated with feelings of pride in one’s work, a sense of accomplishment, respect from peers, and a desire to explore the limits of knowledge, and negative, associated with unattainably high expectations, excessive and unnecessary criticism of self and others, and self-doubt. Depression and burnout were measured using the validated Patient Health Questionaire-9 (PHQ-9) and Burnout Assessment Tool (BAT). Results: There were 76 respondents (11 residents and 65 attending physicians), of whom 64 were (84.2%) male and 12 (15.8%) female. Of these respondents, 18 (23.7%) met the threshold for clinical burnout, and 25 (32.9%) met the threshold for mild depression. Having children was protective against negative aspects of perfectionism (OR 0.30; 95% CI 0.09-1.0; p = 0.049) and was associated with decreased levels of burnout (OR 0.27; 95% CI 0.08-0.91; p = 0.034). Being a perfectionist was associated with higher clinical burnout levels (OR 5.0; 95% CI 1.5-16.9; p = 0.011) and depression (OR 4.0; 95% CI 1.4-11.3; p = 0.009). Conclusion: Negative perfectionist tendencies such as unrealistic self-expectations, excessive self-criticism, and irrational fear of failure are associated with burnout and depression among orthopaedic surgeons. Having children is a protective factor against perfectionism and burnout. These results highlight the importance of understanding perfection within orthopaedic surgery.