Can we be Real?

“Doctor I want a nice nose I want it turned up and narrowed just a little but not too much, I want it to look cute, natural, like this photo on my phone…but I am sure you know what I want… you are the expert… just make it perfect.”

Have you heard this before? Or better yet how often do you hear this? Is perfection becoming increasingly more expected? And if so why? Is it unique to aesthetic patients or is it just a symptom of an id driven society that is becoming accustomed to nothing less than the ideal?

I am in my 15th year of practice and I believe expectations for perfection or for the ideal is exponentially expanding. Patients during consultation often request their favorite movie star’s nose, guaranteed outcomes and for the first time ever refunds if ideals are not met. My inkling is that this entitlement has been sparked by an overserved Gen X, and an over nursed Millennial generation. Both who seem unable to temper primal urges to guzzle in all they can from their mobile phone and camera loaded with apps that allow living a virtually ideal moment at the swipe of the finger. Photos that don’t match the ideal can be immediately disposed until the right one is achieved. And if just shy of perfection, the chosen one can be morphed, filtered and contrasted until the perfect trophy of shadows, proportions and angles are realized. A story is created and it is ready for uploading to the social media fa?ade of choice. Such an ability to quickly evaluate manipulate and achieve the perfect version of “me” and my life perhaps contributes to an empowered consumer who has a deified given right to always be pleased.

But are we physicians partly responsible for the patients’ inflated expectations? Are we swallowed up into the vocal majority and ushered to the front of the crowd promoting a false idealism with over promising videos, Instagram, Snap Chat stories and social media chatter?

Granted since the beginning of recorded civilization idealistic values have always existed been desired and promoted as a standard by which we should aim. From Greece’s Pantheon of Gods to Plato’s Forms, Biblical Commandments to DaVinci’s Vitruvian man. But history’s idealist have been tempered by gnostic sobriety recognizing that perfection was allegorical in nature, even Moses perhaps the most righteous man to have existed was separated from perfection by 2 sins.

Wanting the ideal has always been preached, but even Plato knew we could only see the shadows of it. And perhaps it is our lack of perfection that fuels idealistic philosophies of Buddhism, Karl Marx and Kant. But achieving pure idealism rarely succeeds in a world inhabited by an imperfect humanity. Perhaps for the very few enlightened a life dictated by the ideal can succeed but an idealism that is absolute along with the ideologues that preach the faith eventually tend to break under the weight of their own narcissism. Look no further then Plato’s republic to Marx’s communism to Hitler Final Solution to modern day fanatics of all religions, crafts and trades unwilling to welcome the pragmatic. Idealism leads to darkness, the literalist of 5th Century arguably drew in a medieval age that saw idealism trump empiricism. A dogmatic cloud halted intellectual, cultural and medical progress for almost 1000 years. Not until a reformation and an Italian rebirth welcomed in opposing thought and discourse did human culture awaken.

Cultural enlightenment is fueled by a pragmatism that bypasses the barriers set up by idealistic people and extremes. And while the idealist may receive immediate reinforcement and shiny accolades, a looming uncertainty always exist. The pragmatist in contrast is a marathoner defined in retrospect and nearly always celebrated for victories.

Pragmatics tend to be compromising and open to bending with a big picture focus. Many don’t realize Lincoln the ultimate pragmatist signed the emancipation proclamation freeing slaves in 11 states and the territories yet Tennessee was not included. An astute political compromise needed to keep Tennessee on the side of the Union. Kennedy may have stared down Khrushchev during the Cuban missile crisis but he also agreed to remove US weapons harnessed in Turkey and even Churchill a staunch idealist softened his stand in order to forge an alliance with Stalin.

However, today we seem to have a creeping neo-idealism that fuels populism. An idealism that is spouted by idealist who prey on the na?ve, young and emotionally vulnerable by selling dreams they know can’t be delivered. While this neo-idealism is overtly seen served up by our media savvy politicians feeding a ratings hungry 24/ 7 news cycle, it can also be seen more covertly by the bombardment of advertisements for Caribbean resorts promising blossoming romance and pills promising prolonged marital bliss. The perfect life seems so easy for all to grasp. However we pragmatically know that the politicians rarely deliver on their promises, it occasionally rains in the Caribbean and meaningful love is not forged by a little blue pill.

In the practice of medicine we as physicians might want to be cautious to recognize the creeping idealism that tugs at our vulnerabilities as well. Whether it is idealistic academics who team up with bureaucrats preaching new treatment paradigms, overpromising device companies promising us happy patients and financial whirlwinds and consultants quick to tell us how to run our practices not knowing the stresses and day to day burdens of making it work.

The ideal is and always has been a figment of our imagination. The movie is never as good as the book, our life may never be as glamourous as Brad and Angelina’s and our vacations never as perfect as the family with the Facebook post from Fiji. Similarly, our practices may never seem to reach the level of proficiency that we envisioned or the standards that are set forth by the consultants and our outcomes may not all be perfect. But shouldn’t that be ok? Aren’t we the ones who say the enemy of good is perfect, that we can’t make a silk purse from a sow’s ear to understand that sometimes we accept “as good as it gets.” As the die -hard commitment for perfection may not be worth the risk incurred and the pot of gold never as rewarding as the rainbow. More than anyone else… in medicine we have a duty to shoot for the ideal but recognize the pragmatic.

However, we have a consumer population increasingly becoming accustomed to the ideal perhaps fixated on perfection and highly susceptible to advertisements and promotions in which we promise the ideal.   Beyond our fiduciary and ethical responsibility to do what’s in the best interest of our patients, the material retribution of over promising the ideal includes false expectations, dissatisfaction and disappointment. It is human nature to desire the ideal but it may not be what we can deliver. The future of our success individually, collectively and personally requires a path that is more likely paved by a sober pragmatism then a fleeting mirage of perfection.

Steve Dayan, MD

[email protected]

312 335 2070