When Obsessive-Compulsive Traits Meet Medicine: Managing the Drive for Perfection

Medicine attracts a certain type of person, which you may have noticed in your med school class, or working with other MDs.  In fact, there are certain sets of personality traits that are much more prevalent in physicians, including obsessive-compulsive behaviors, narcissism, and attention deficit and hyperactivity¹. 

In this first of 3 posts about personality types in medicine, we will discuss obsessive-compulsive traits.  Please note that I have intentionally steered away from the formal psychiatric diagnosis of “obsessive-compulsive disorder” and will instead focus on some of the features associated with the official disorder.

The field of medicine rewards some degree of these characteristics, including meticulousness, attention to detail, and a willingness to double or even triple check your work.  However, when unchecked, they can lead to inefficiency, strained relationships, and burnout.

As a physician, you might recognize some of these patterns in yourself.  The goal is not to eliminate them (they can make you a safer physician), but to channel them so that you can serve your patient population without it consuming you.

Here are 5 common ways obsessive-compulsive tendencies show up in medicine, and practical strategies to manage them:

Obsessing over the possibility of patient error

The transition from supervised trainee to attending can feel heavy. Suddenly, your safety net is gone, and all decisions are yours, including the consequences that you were previously shielded from. It’s normal to feel vigilant, but that vigilance can morph into excessive worrying about missing something.

Risks:

• Endless re-checking of charts or test results

• Inability to mentally leave work

• Decreased confidence and increased fatigue

  
  

What helps:

• Build safety nets, in the form of checklists, EMR alerts, and structured hand over

• Define a ‘stop point’: once you’ve reviewed everything, refuse the temptation to go over the same things again

• Lean on your team: trust your colleagues and allied health professionals

• Replace endless rumination with scheduled reflection times

• Be kind to yourself: vigilance is strength, obsession is not

Micromanaging and fixating on the wrong things

Many new staff MDs feel that they need to prove themselves by controlling every detail.  This often translates into rewriting notes, fussing over formatting, or second-guessing orders, all while missing bigger priorities.

Risks:

• Allied health professionals and support staff feel undermined and disengaged

• You become the ‘bottleneck’ of workflow

• Valuable time and energy get wasted on low-stakes details

What helps:

• Differentiate critical vs. cosmetic: does this affect the overall outcome?

• Empower staff: tell them, “I trust your judgement here.”

• Look at delegation as multiplying your impact, not losing control

• Reflect at the end of the day: Did I move the patient’s care forward, or get stuck in the weeds?

Paralysis in the pursuit of perfection

Some physicians hesitate to act until they’ve found the perfect plan.  But in medicine, waiting for certainty can delay care and worsen outcomes.

Risks:

• Clinical delays and frustrated patients and colleagues

• Decision fatigue from over-analysis

• Missed opportunities in career or leadership roles

  
  

What helps:

• Use the ‘good enough’ rule: if the plan is safe, evidence-based, and reasonable, do it

• Use the ‘80/20’ principle: the most benefit comes from timely decisions. To quote Harry S. Truman, “Imperfect action beats perfect inaction every time.”

• Time-box your decisions: set time limits for routine and complex cases

• Reframe uncertainty as an inevitable part of medicine, not a failure

Over-documenting and over-preparing

Physicians with compulsive traits often write overly long notes or spend excessive time preparing for routine patient visits.

Risks:

• Hours lost to charting, which cuts into personal time

• Notes that are less useful to the reader because of unnecessary detail

• Fatigue from the feeling of never being ‘caught up’

What helps:

• Embrace the idea of ‘minimum effective documentation’: clear and accurate, but concise

• Use templates and AI scribes

• Tailor notes to the intended audience: for specialists, just answer the question

• Protect your time: set boundaries for paperwork

Difficulty switching off

Even when away from work, many MDs with obsessive tendencies replay patient encounters in their minds or compulsively check their EMRs

Risks:

• Poor work-life balance and higher risk of burnout

• Strained personal relationships

• Fatigue that increases the risk of medical errors

What helps:

• Set clear ‘off duty’ boundaries and stick to them

• Create ‘transition rituals’ after leaving work, like exercise or journaling

• Capture worries in a next-day task list instead of ruminating

• Reframe rest as professionalism: a rested physician makes better decisions

In conclusion, obsessive compulsive traits are not flaws; in fact, they often help you deliver safe, meticulous care.  But when they tip over into obsession, micromanagement, or perfectionism, they harm both you and your patients. 

The key is balance:

• Structure, not rumination

• Progress, not perfection

• Delegation, not total control

• Rest, not relentless vigilance

Your patients need your care to be careful and thoughtful, but also sustainable.  The best medicine is not ‘perfect’, but good, effective, and practiced by an MD who will be there long-term.

Reference

1.  “Most Common Personality Disorders in Medical Doctors” Joe Hannan, March 24, 2023. https://www.mdlinx.com/article/most-common-personality-disorders-among-mds/2U0jtRmLeJx9WOHtG4eGpu

Author: Dr. Krishna Sharma, Director of Physician Engagement, Specialty Medical Partners

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