When healing hurts: Perfectionism as a patient safety risk in medicine

Background: Perfectionism is deeply embedded within medical culture and is frequently associated with clinical excellence, diligence, and professional competence. However, when reinforced structurally, perfectionism may function as an under-recognised patient safety risk factor.

Aim: This paper examines the cognitive, behavioural, ethical, and organisational consequences of perfectionism in medicine and evaluates whether perfectionism-driven burnout constitutes a system-level patient safety concern.

Methods: This paper adopts a conceptual and interdisciplinary approach informed by principlism, moral distress theory, neuroscience, organisational psychology, and contemporary patient safety literature. Australian and international regulatory developments are also examined.

Results: The analysis suggests that maladaptive perfectionism may contribute to cognitive overload, impaired clinical judgement, defensive medical practices, reduced help-seeking behaviour, and moral distress. These risks may be amplified in under-resourced healthcare systems where workforce shortages, financial constraints, and limited infrastructure intensify cognitive and ethical strain. Organisational structures, including rostering practices, productivity metrics, and hierarchical cultures, may further reinforce unsustainable professional expectations.

Conclusion: Perfectionism in medicine should not be understood solely as an individual personality trait but as a structurally reinforced phenomenon with implications for clinician well-being and patient safety. The paper argues for a recalibration of medical excellence toward sustainable competence, reflective practice, and systems that support safe and ethically sustainable care delivery.