The Illusion of Perfection: Part 1

Medicine’s Most Dangerous Myth

Perfection is a lie.
A mirage.
A neurological glitch wrapped in white coats and stitched into our stethoscopes.

In medicine, we chase it anyway. Relentlessly. Because the stakes are high, the risks are real, and the cost of failure is human life. So we aim for perfect diagnoses, perfect notes, perfect interactions, perfect outcomes. Flawless.

But the truth?
We miss things.
We misread.
We are human.

And that’s not the problem.

The problem is what comes after the miss. The silence. The shame. The system designed to punish imperfection rather than learn from it. The unspoken expectation that if you’re not perfect, you’re dangerous. That vulnerability is weakness. That accountability equals blame.

Dr. Peter Smulowitz cracked that illusion wide open.
In a gut-wrenching, honest retelling of a diagnostic miss, he reminds us:

We all make mistakes. Even when we don’t, unanticipated events still happen to our patients.

That’s not just a reality—
That’s a biological inevitability in complex systems like healthcare. The human body isn’t a machine. Medicine isn’t a perfect science. It’s a probabilistic art form. High stakes jazz. And sometimes, even the best improvisers hit a wrong note.

Yet we treat error like heresy.

The consequences?
Physician suicide. Depression. Substance abuse. Isolation.
Hospitals that hide. Families left in the dark.
A culture more committed to avoiding liability than seeking truth.

We call it professionalism.
But it’s just fear in a lab coat.

So what do we do?

We break the cycle.
We tell the truth.
We talk about error not as moral failure but as data—painful, yes—but instructive. We rebuild the system around transparency, trust, and transformation. We call it CARe: Communication, Apology, and Resolution. Not just a program—
A cultural pivot.

Dr. Smulowitz lived it. The anguish. The lawsuit. The impossible guilt. The desire for forgiveness. The refusal to be defined by one moment, even as it shaped every day since. See the final paragraph from his BMJ article and watch the video below to see how the family responded. 

I often wonder how my patient’s family is. While my pain and years of struggle are real, at least I had a second chance. His parents lost a child. Maybe they hold me responsible, maybe not. Undoubtedly they have a picture in their mind of what I look like and who I am, and in my perverted reality this picture shows me as incompetent and lacking compassion. But I want them to understand how so sorry I am for what happened to their son, and that his loss is a part of who I am and how I perceive every day of my life. Maybe I even long for their forgiveness, or even just a measure of acceptance that I am an imperfect but thoughtful and compassionate human being who would have never thought in a million years that this could happen to one of my patients, or that it might even have been my fault.

That paragraph hits like a defibrillator to the soul.

Because it’s all of us.
Every physician who lies awake wondering if they missed something.
Every nurse carrying stories that never got told.
Every human in this inhuman system.

It’s time we dismantle the myth of perfection. Not just for us—but for the patients we serve. For the families who deserve truth. For the next generation who need to know that growth starts where perfection ends.

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What next:
In our second post, we will approach how to implement the solution called CARe – Communication, Apology and Resolution. A ‘how to guide’ for those wishing to start this in their own institution. 

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References

• Smulowitz P. The illusion of perfection. BMJ Qual Saf. 2020 Apr;29(4): 345-347.