68% of us are statistically “average.” Whilst being an average weight or height may be acceptable, no-one wants to be an average parent, have an average income or be an average doctor. What does average actually mean and what are the implications for our patients?
Are you average? When it comes to who we are physically there is a simple bell shaped curve that describes the population within which we exist whether that is people from “our” socio-economic group, age or even profession. What height is the average American woman? What size shoes does she wear, excluding those fabulous ones seen in the sales but just weren’t the right size but you crush your feet into because, well just because….
And then what about how much coffee or alcohol you drink? Where do you fit into the curve? Because there is a curve for that. Does the barista at the local coffee shop know your order and is that because she likes you or that you are funding her college fees? What is average? Some of these things we are dealt by nature and can’t really change, like height or shoe size but some we have issues about and may want to change or hide like weight or number of sexual partners. Why though? What is it about average that we don’t like?
What then does it mean to be an average physician. Because, for the simple statistical reasons 68% must be average physicians. That’s what bell curves and standard deviations do to statistics however we gather or measure the data. We all know some amazing doctors and some poor ones but actually the rest are probably…average. But who wants to be looked after by an average doctor? Not me! So, most of us would push harder, stay later, study longer to improve our standing in the group and move above that average. Which is good, of course? But here’s the thing, we should all do that. And if we all did that the whole bell curve would shift to the right and…we’d be right back where we started again; better healthcare but we are still average.
So, what does average actually mean as a physician? Is it a bad thing or is good, good enough?
A chief of mine loved aphorisms: sayings that explain things. One of his favourites was “the enemy of good is perfect.” Good, is average really. The enemy of average is perfect. As a phrase it probably came from nowhere in particular but Voltaire is certainly credited with its popularisation.
“The enemy of good is perfect.” How does that make you feel? The psychological literature would suggest that there are two responses to this. The first view is that it doesn’t really make sense, because surely excellence, that quality of being better than average, is about striving towards perfection, isn’t it? Shouldn’t it be, “the enemy of perfect is good?” Surely perfection, that excellence we seek, is defined by the absence and avoidance of error. And yet Spicer and by extension Voltaire didn’t say that, they said “the enemy of good is perfect,” which is different. What does it mean to accept good rather than perfect?
Does our view of average come from our self-criticism? Who wants to be an average parent, an average lover? We recognise we may have flaws but does that mean you are no good? Is the opposite of perfect, failure? Or is there value in that?
Now when it comes to making mistakes there are those of us who actually are VERY happy to list all our mistakes. We are ALL about mistakes. We firmly believe in the Imposter Syndrome and firmly believe that Drs Dunning and Kruger were looking directly at us when they wrote their paper. Some would wear “average” almost as a badge of honour itself. Some of us actually want to be average. We never think we are good enough and that everyone is better than we are. Dunning and Kruger had something to say about that and it probably isn’t what you think it is.
So who cares if we are average? Does it limit your ability? Does it predict your future performance? And what actually is performance about? If one member of a team is excellent, does that guarantee excellent performance? Conversely, if none of the team is excellent does that preclude excellence? What is our perspective and is that the most important view? I think we have the wrong idea what excellence is; excellence in care is NOT what you think it is. What it is, is actually liberating and inspiring….
Watch the full FIX17 talk below!