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Conquering failure

Dermatologists discuss their experiences and perceptions of failure while providing strategies for overcoming setbacks


Conquering failure

Dermatologists discuss their experiences and perceptions of failure while providing strategies for overcoming setbacks


By Allison Evans, assistant managing editor

Most are familiar with the truisms surrounding failure: It’s necessary for success; it’s inevitable; it’s how we learn and grow. Despite hearing these phrases consistently, many still hate to fail, and the experience can be paralyzing and debilitating for some. 

With the pressures associated with earning the MD or DO designation, physicians — particularly dermatologists — may face a unique struggle addressing setbacks when they occur. This month, Dermatology World addresses what failure means to several dermatologists and shares strategies to help physicians move through these experiences and come out stronger.

The cost of perfectionism

Were you the type of student for whom receiving a B+ on an exam caused heart palpitations? Many can relate to the double-edged sword that is perfectionism. To perfectionists, shades of gray are replaced with the black and white of failure or success. According to Amy Morin, a licensed clinical social worker, author, and psychology lecturer at Northeastern University, perfectionism has a cost. “Studies show perfectionists are actually less likely to succeed and they’re more likely to experience mental health problems, such as anxiety and depression. Some research has even linked perfectionism to early death,” she explained (doi.org/10.1177/1359105309103571).

“In the past, if you didn’t show any cracks, nothing could be wrong. It was all about putting on a nice veneer no matter what was going on internally,” said Tara Oetken, MD, a fourth-year dermatology resident at the University of Arkansas for Medical Sciences. As she approaches the end of her residency, Dr. Oetken is seeing a shift in perceptions about failure, especially since perfectionistic tendencies have been identified as one of the many causes of physician burnout.

Derm360

Overcome practice challenges, assess your stress levels, and recharge your motivation at staging.aad.org/burnout.

“Refusing to acknowledge your pain can temporarily prevent you from feeling hurt,” said Morin, “But, ultimately, the refusal to address the problem head-on will drain you of the mental strength you need to become your best.”

The neuroscience of failure

In the book The Winner Effect: The neuroscience of success and failure, neuroscientist and professor of psychology Ian Robertson, PhD, describes how those who have more life successes experience changes in brain chemistry that make them more likely to be smarter, more confident, and more likely to succeed in the future. 

On the flip side, some research shows a similar pattern has emerged with failure: Failing once may make a person more likely to fail again at the same goal. In one study, dieters who were fed pizza were convinced that they “ruined” their daily diet goal, and subsequently ate 50% more cookies immediately afterward — compared to those who ate pizza and were not on a diet (doi.org/10.1016/j.appet.2010.07.015). Not only does failing potentially lead to more failing — but it may lead to more catastrophic failure. 

Since failure is inevitable, what can be taken away from this type of research? Perception is everything. It wasn’t that the dieters were told they were failures, but rather, they had convinced themselves that they “ruined’ their diet. They deemed themselves failures, which propagated the cycle. 

What’s in a name?

Ultimately, a failure is only what we make of it. “There’s no rule book that says this is a failure. It’s up to us to define it,” said Sara Dill, MD, a dermatologist and life coach. “I like to think about failure as something we expected to have happen that didn’t, or something happened that we didn’t expect to have happen,” she said. She poses the difference in thought like this: “‘I’ve failed’ versus ‘these actions I took resulted in this outcome, which isn’t what I wanted. How else could I do it?’” 

Approaching the problem scientifically may help keep the outcome from being taken too personally, Dr. Dill explained. “You had a hypothesis, you tested it, and it didn’t work. Now what?” For physicians in particular, this may be a familiar mindset from their training that could be adapted for personal growth. 

One of the ways Dr. Dill approaches this with clients is asking them what they are making the “failure” mean about themselves versus accepting that negative outcomes sometimes just happen. “If I was a better doctor, would I have better outcomes?” Once you take away the focus from yourself as a person, she said, you can start to explore other factors outside yourself that may impact outcomes. “As physicians, we always have a responsibility to look at how we could do things differently in the future. This is how we evolve as a profession,” she said.

Eliot Mostow, MD, MPH, chair of the Academy’s Practice Operations Committee and chair of the dermatology section at Northeast Ohio Medical University, has also dealt with perceptions of failure. Over the course of his career, he has re-certified twice. “The first time I took the exam, I passed, but I think I only passed by like one or two questions,” he said. Although he passed both exams, after each one he was confronted with feelings of failure in that his expectations — acing the exam — were not in line with the result, despite the fact that he passed.

‘To err is human’

The proverbial phrase “To err is human” originated from the 18th century English poet Alexander Pope, and as one of the most quoted writers in the English language, there is wisdom in his words.

“Self-compassion is a key component to rebounding from failure,” said Morin. Avoid calling yourself names, beating up on yourself, or doling out harsh criticism. Instead, speak to yourself the same way you’d talk to a trusted friend, she recommended.

While Dr. Mostow knows he’s not failing in his life, he acknowledges that juggling so many pieces in his professional and personal life can make him feel like he’s barely keeping his head above water. “My wife and family are really most important, and the patients are important, but my staff is also important. Juggling those balls takes focus and some level of forgiveness — forgiveness that I’m not always going to get it right all the time.”

For physicians, adopting the right mindset is particularly important because it can ultimately impact patient care. The physician who thinks, “I made a bad choice,” is likely to do better in the future compared to the physician who thinks, “I’m a bad person,” Morin said.

Calculated failures

Dr. Mostow makes decisions about where he can get away with falling short. One of the stresses he struggles with in practice is keeping on schedule. “My approach is that as long as you’re in my office, I’m going to take care of as many problems as I possibly can.” The goal is to accommodate as many concerns to help each patient. 

“The failure may be — and it’s a calculated failure — that I’m going to run behind more often so that I can give each patient my undivided attention. I’m both failing and succeeding and being satisfied with that outcome,” he explained. “Sometimes there are competing interests and you have to say we’ve made a calculated decision to do things this way.”

At the Academy’s 2019 Annual Meeting in Washington, D.C., Dr. Mostow presented on physician burnout. One of his colleagues who also spoke at the symposium was Jessica Kaffenberger, MD, assistant professor of dermatology at Ohio State University. Her innovative approach to battling burnout is not the traditional advice to engage in activities outside of work (e.g., go on vacation, exercise, don’t take work home, etc.), but rather, being proactive in living a happier life. 

Dr. Kaffenberger speaks about three action-oriented pillars of happiness referenced by the mnemonic BIG: bonds, impact, and gratitude. Doubling down on efforts to create and maintain relationships, helping others, and being grateful for what we have is her answer to staving off burnout. (Read Dr. Kaffenberger’s commentary about rediscovering happiness in medicine at www.practiceupdate.com/c/89698/2/4.) Dr. Mostow believes that these three pillars may also be a productive way to deal with failure as well in that it becomes much more difficult to dwell on the negative when focused on BIG.

A fear of failure

The fear of failure, also called “atychiphobia,” can cause even the most successful person to stall and fall flat. “The notion that you should never make a mistake won’t actually prevent you from making a mistake. Instead, it’ll stop you from doing anything where you might fail,” Morin said.

Dr. Dill calls this “failing ahead of time,” which is when “we don’t go after something we really want because we’re so worried about failing or being disappointed by not having it turn out. We disappoint ourselves ahead of time by never doing it.”

Johannes Haushofer, PhD, assistant professor of psychology and public affairs at Princeton University is, on paper, extremely successful: Dual doctoral degrees, a professorship at one of the country’s top universities, a long list of publications. But after realizing that his resume showcased only his successes, he confronted failure head on by publishing a CV of failures. 

“Most of what I try fails, but these failures are often invisible, while the successes are visible,” Dr. Haushofer noted in the CV. “I have noticed that this sometimes gives others the impression that most things work out for me. As a result, they are more likely to attribute their own failures to themselves, rather than the fact that the world is stochastic, applications are crapshoots, and selection committees and referees have bad days.”

In his CV, Dr. Haushofer chronicled the failures he could remember, which included a list of degree programs he did not get into; academic positions, fellowships, and awards he did not receive; and rejections from academic journals.

The negativity bias

As a physician and life coach, Dr. Dill chose to focus her coaching career primarily on physicians because she recognizes unique traits and qualities they often share when struggling. The negativity bias, simply put, means that negative events have a greater impact on our brains than positive ones — and it’s something all people experience. The sting of not getting into a dermatology residency on first application may have a longer-lasting impact than the joy of getting accepted on first try. The human brain is wired to recall traumatic or negative experiences more vividly, she said. 

It’s thought that the negativity bias stems from the evolutionary need to pay attention to threats for the greatest chance at survival. “As physicians, we have this negativity bias, and that’s normal. One way that it manifests in medicine is that we’re always looking for what’s wrong,” she said, “and while that’s helped us survive, it doesn’t help us thrive.” 

She finds that simply noting this tendency to think a certain way helps to manage it and not let it run the show. Often that tendency to look for problems leads to dissatisfaction in other areas of life, Dr. Dill noted. However, armed with some self-awareness of how our brains function, the impact of the negativity can be mitigated.

Mentorship

As a mentor to medical students, Dr. Mostow witnesses failure regularly. Due to the highly competitive nature of the specialty, inevitably, some students do not match with a dermatology residency program. Being vocal about the failure, and helping to normalize it, can take the focus away from it becoming a personal shame. “When you’re being mentored, talking about failures can be normal, such as how many times you have to apply to even get into dermatology,” Dr. Dill said. 

When Dr. Mostow used to interview potential dermatology residents, he often asked: What if you weren’t allowed to do dermatology? Many interviewees would respond that they would simply keep trying. “But what if you weren’t allowed to do it,” he would prod, “you have to do something else.” Some would continue with a “dermatology-or-bust” attitude, which he found concerning.

Feeling the burn

Learn more about sources of dermatologist burnout and mitigating strategies at staging.aad.org/dw/monthly/2017/september/feeling-the-burn.

“I nurture the attitude that says, ‘you can do a lot of things; you’re a good, smart person.’ Getting into dermatology is not everything,” Dr. Mostow added, hoping students might avoid the binary, black-and-white thinking that can make recovering from failures even more challenging.

Moving forward

A pearl of wisdom Dr. Dill gleaned from her own experience is that she doesn’t expect her job to make her happy. “In medicine, we feel like it’s this big life calling, and that can be great. But even life callings can get tedious sometimes.” Like any career, there are parts that aren’t as fun, she said. “Now when I show up to the office, I’m different. I no longer make myself overly responsible for my patients’ outcomes.” A poor outcome is no longer a reflection of the kind of physician I am, she affirmed. 

For Dr. Dill, the challenge is not only ensuring the best care for patients, but also creating a professional culture of wellness that’s top down and bottom up. “How can we make sure that the system is not only ensuring the best care for patients, but that the people providing that care — at all levels — are also thriving, too?” 

“This culture of working harder, being perfect, not asking for help, not showing emotion — some of this is slowly changing, but I’d still say that it’s the norm. When push comes to shove, you go to the bathroom if you have to cry,” she said.

As Dr. Haushofer demonstrated in his CV of failures, appearances can be deceiving. “In the era of social media and everyone’s life looking perfect on paper, it’s, again, important to remind ourselves that we can’t compare our own internal world to people’s external appearance of their life — it’s a very different thing,” Dr. Dill said.

“By simply being a dermatologist, you are likely somewhat of a perfectionist and/or overachiever. That is just what it takes to make it into such a competitive field,” Dr. Oetken noted. “No one lives an Instagram-perfect life and that is okay.”