The "Good-ish" Doctor

What if the goal isn't to be a good doctor—but a good-ish one?

In this episode of The Only Life You Could Save, Dr. Cassie Ferguson explores the perfectionism, self-doubt, and fear of failure that so often accompany a career in medicine. Through stories from medical school, clinical practice, and her own experience receiving a painful patient complaint, she examines why our attachment to being "good" can sometimes get in the way of growth.

Drawing on the work of social psychologist Dolly Chugh, Dr. Ferguson introduces the concept of being goodish—the idea that real learning begins when we stop defending our mistakes and start becoming curious about them. She reflects on uncertainty in medicine, the discomfort of feedback, and the challenge of holding joy and heartbreak at the same time.

This episode is a reminder that thriving in medicine is not about becoming flawless. It's about developing the courage to remain open to uncertainty, to learn from mistakes, and to trust that your worth does not depend on perfection.

In this episode:

• The fear of not being enough in medical school and beyond
• Why uncertainty never disappears in medicine
• A patient complaint that became an unexpected teacher
• Dolly Chugh's concept of being "goodish"
• The psychology of defensiveness and growth
• Learning from mistakes without becoming defined by them
• Holding joy and suffering at the same time
• Belonging, self-doubt, and the myth of having it all figured out
• Why thriving requires changing our relationship to failure

Key Takeaway:
Being a good doctor is not about avoiding mistakes. It's about developing the humility, self-awareness, and courage to learn from them. When we let go of the impossible goal of perfection, we create space for growth, compassion, and a more sustainable way of practicing medicine.

Transcript

SPEAKER_00 0:16

Welcome back. I am so glad that you're here. Today's episode begins in the back row of a medical school lecture hall in Milwaukee, Wisconsin, where I first started to wrestle with the fear that I wasn't enough. That fear followed me, not just through exams, but through hospital corridors, patient rooms, and moments of painful self-doubt as an attending physician. In this episode, I'll share a story about a patient complaint that forced me to confront one of the hardest truths in medicine: that even when we try our best, we don't always get it right. We'll talk about why striving to be a good doctor or a good person can actually get in the way of growing into a better one. And I'll introduce you to the concept of being goodish, a term die borrowed from social psychologist Dolly Chugg, who reminds us that real growth begins not in perfection, but in our willingness to look at our mistakes. We'll also explore how to hold both joy and pain at once, how to navigate the emotional paradoxes of a life in medicine, and how to stay grounded in your own sense of belonging, even when everything feels uncertain. So whether you're just starting medical school, deep in your training, or years into practice, I hope these stories remind you of something important. You're not alone. You don't have to be perfect. And maybe being good-ish is exactly what this work and your patients need most. So, way back in August of 2000, one year after I graduated from UCLA, I drove from Oakland, California to Milwaukee, Wisconsin in my Plymouth breeze to start medical school by myself. I met my roommates the day I moved into our apartment. I'm pretty sure I was the very last person admitted off the waiting list, and I was terrified that my undergraduate degree in psychology and my C- in general chemistry meant that I would not cut it academically. I'm also an introvert by nature and have always lived with a sense that other people wouldn't be interested in talking with me. Making friends is typically a painful exercise that entails me trying desperately to think of something cool to say. During the first weeks of class as a first-year student, when we were learning biochemistry, I would come and sit in the very back row of our auditorium. I studied by myself. When I had questions, I would look for the answers on my own. I was convinced that I was the only one who wasn't getting it and that everyone else was a biochem major in college. When I didn't pass my first biochem test three weeks into the first semester, I woke up. It occurred to me that I could continue hiding in the back, or I could acknowledge that I was allowing the fear of what other people would think of me, the uncertainty of whether I belonged here, to get in the way of becoming a physician. So I moved closer to the front of the class, I asked my peers for help, and I discovered that I was not the only one who felt that way. I also discovered that not only were many of my peers, in fact, biochemistry majors, they were also incredible teachers. Competition, a word that often has a negative connotation, actually comes from the Latin word compitere, which means to strive together. My willingness to ask for help early and my classmates' willingness to help me ensured that I passed biochem and solidified many important friendships. It turns out, though, that this sense of uncertainty about being enough never really went away. In medicine, uncertainty comes up all the time. On a shift in the emergency department now, I might see 30 patients. On a good day, I'm 100% certain about my diagnosis and plan about 20% of the time. And there's typically at least one diagnosis that I am 100% certain was wrong. But I know there was a time in my training when I thought that when I became an attending physician, I would know so much that I would be certain all the time, that I would know so much I wouldn't make mistakes, at least not big ones. The problem with this plan is that when I became an attending physician, I remained human. Nearly all the stories I share when I'm talking to students or residents or attendings about well-being are about that humanity, including this one. Three years ago, I was on shift in the emergency department and received an email from our patient experience office. These are never emails you want to get as a physician. They are never emailing you to tell you about a fantastic experience a patient had in your care. It turns out those emails are for cardiothoracic surgeons, by the way. Going into emergency medicine means accepting that you will not be receiving those kinds of emails. No, this email came from one of our patient relations specialists, and in it was feedback from the mom of one of the patients I had cared for the month prior. She wrote, among other things, that her child left the emergency department no better than how she arrived, that she needed more help than I provided, and that I seemed overwhelmed by her child's issues. It was very clear that she was talking about me because she made a point of remembering my name and using it multiple times in her letter. I was very disappointed in Dr. Ferguson's care. Dr. Ferguson was not equipped to deal with my daughter's problem. As I read the complaint, my heart started to race, my jaw set, my face flushed. In his book Emotional Intelligence, Dan Goldman calls this response an amygdala hijack. Patient complaints might be described as doctor's modern-day saber-toothed tiger, which is really no wonder given how entwined our identity as a physician is with our identity as a person. In my amygdala fog, the thoughts that immediately entered my mind when I read this complaint were that this mother didn't understand the complexity of her daughter's problem, that the resources I offered were the only ones that we had available, that I had called multiple people to help her, and that they had all refused. And the thought that I am least proud of that she was just ungrateful. Over the next few hours and days, as the acute stress response wore off, those thoughts gave way to other, more self-critical thoughts. Thoughts that are born out of my conditioning as someone who has learned that perfectionism paves the way to love and acceptance from parents, from teachers, from friends. As we've talked about in another episode, I've learned through therapy and my meditation practice to name this voice. So Rhys Witherspoon showed up and said, another physician would have handled this better. You should have spent more time with her. You aren't as empathic as you think you are. I struggle with Reese mightily. She has been my constant, unwanted companion throughout my life. Most physicians I speak with are resigned to the inevitability of patient experience surveys. We understand the importance of the opportunity to provide feedback for patients, for their families, and for the institutions in which we work. We also know that patients and their families are the undeniable source of truth about their experiences while in our care, and most of us are eager to know how we're doing. We come to work with the intention of providing high quality care. Yet many physicians, like me, struggle with being the subject of these patient experience surveys and with finding a way to learn from them. So much so that our brains react to them as if we're in mortal danger. But what has begun to occur to me over the past few years in both my personal and professional lives is that I struggle to receive and learn from negative feedback because I'm wholly attached to a certain way of seeing myself, both as a physician and as a human being. I care very deeply about being a good doctor and frankly about being seen by others as a good doctor. I also care about being a good person. Social science research tells me that I'm not alone. Whatever our definition of a good person, most of us place considerable value on this identity. And I am a good doctor. I'm an empathic and caring doctor. I'm also a good person. Except when I'm not. Except when my empathy wanes, and I don't care for a child in the way that a parent needs me to care for them. Except when I talk badly about someone behind their back. When I make an assumption about someone based on the clothes they're wearing, or their race, or their gender, or their ethnicity. Dolly Chugg, a social scientist who studies the psychology of good people, explains that this attachment to being a good person and the moral value that we place on that identity is what sends us into what she calls red zone defensiveness when we make mistakes that hurt other people or promote injustice, despite our best efforts. In that defensive stance, we immediately try to explain away our mistakes, making it impossible to learn from them. We're so busy trying to protect that good person identity that we don't take any steps toward actually becoming a better person. Right? It's not my fault the patient's mother wasn't satisfied with my care. I did all the right things. She's just ungrateful. She talks about people behind their backs all the time. She had it coming. I'm not biased. Look at all the things I'm doing to advance equity. Chug explains that this kind of defensiveness may be in part due to thinking that being a good person is supposed to be easy. Most of us have this definition of a good person that's either or. Either I am a good person or I'm not. Either I am an empathic doctor or I'm not. Either I'm biased or I'm not. And this thinking leaves us paralyzed when we do make a mistake. How do we reconcile our intense need to be a good person with the reality that we are going to mess up? Chug suggests, and I have found immense value in this suggestion, that we forget about being good people and decide to be goodish people. In her words, a goodish person still makes mistakes. As a goodish person, I'm making them all the time. But as a goodish person, I'm trying to learn from them and own them. I expect them and I go after them. I understand that there are costs to these mistakes. As a goodish person, in fact, I become better at noticing my own mistakes. I don't wait for people to point them out. I practice finding them. I've messed up a lot in my professional life, as a doctor, and I'm sorry to tell you, also as a teacher. When I'm called out for these mistakes, I still go through all the same mental gymnastics I had after getting that patient complaint, the defensiveness, then the self-loathing, then the intense desire to escape. The growth and learning I've done over the last 10 years has not meant that I make fewer mistakes, but it has meant that I recover much more quickly from those mistakes. It's meant that I can see all that's happening in my brain and recognize that they are just thoughts, just my conditioning. I can recognize that it's my need to be seen as a good teacher or a good doctor that was driving my reaction, not my real intention to love, care for, and support those entrusted to my care. As a good-ish person, however, I can sit with the embarrassment and discomfort that comes with acknowledging that I make mistakes and that sometimes these mistakes hurt other people. A goodish person apologizes, reaches out to the people they've hurt, learns from their mistakes, updates their knowledge, gets better. A good person is stagnant, uncomfortable. A goodish person grows. It can feel paradoxical to embrace your goodness and your growth edges. After all, you've been trained to buff your mistakes and your failures, your gap years, your rejection letters until they shine like strengths. But it turns out that thriving as a physician requires we embrace paradox. As a student, I had to get comfortable with doing poorly on an exam and holding fast to the belief that I still belong there. As a resident, I learned what it was to sit at the bedside of a dying child all night and then go out for breakfast with my close friends and let myself laugh the next morning. As an attending physician, I've had to learn to compassionately care for an eight-year-old who was sexually assaulted by her neighbor and still take my kids to the park the next day and play with them. In an interview that author and meditation teacher Sharon Salzberg did with Krista Tippett for the On Being podcast, Salzburg tells a story of going to Parkland, Florida after the school shooting there to meet with survivors. And someone in the room raised her hand and said, I feel really weird because I'm having an incredible experience learning about mindfulness and practicing meditation and being with you. And I know the only reason it's happening is because that horrible thing happened. And then she said, I don't know how to get over that, to be with this. What Salzberg said to that woman in Parkland was, I don't know if we ever get over it so much as we learn to hold them both at once. That's a feeling I've had countless numbers of times in my training and in my practice. Just the other night, I walked out of a trauma bay after caring for a 15-year-old patient who ultimately died of a gunshot wound to his head and found a text from my 15-year-old son on my phone. For most of my medical training, I operated under the assumption that we either have to absorb all the pain we see around us as physicians, let it stitch itself into the fabric of our white coats, or we have to deflect it and avoid feeling it at all. But I just don't believe that that's true. I believe that we can expand our capacity to see and be with the pain we're going through, to see and be with the pain that others are going through, and to hold this larger perspective that there is change in life. Buddhist nun Pema Choudrin wrote, When we feel resentment because the room is too hot, we could meet the heat and feel its fieriness and its heaviness. When we feel resentment because the room is too cold, we can meet the cold and feel its iciness and its bite. When we want to complain about the rain, we could feel its wetness instead. When we worry because the wind is shaking our windows, we can meet the wind and hear its sound. But cutting our expectations for a cure is a gift we can give ourselves. But there is no cure for hot and cold. They will go on forever. Just as happiness and joy comes and goes in our work as physicians, so do sadness and pain. And I've seen so many moments that somehow held joy and pain at the exact same time. I remember vividly watching as a little boy I cared for as a resident in the pediatric intensive care unit, asked to see each of his nurses so that he could hold their hands literal days before his tiny body succumbed to leukemia. And the thing is, we can't selectively block out or numb any one emotion. If we numb the pain of these moments, we end up numbing the joy too. So when you fail, lean into the fear that comes up. When you say something that hurts one of your colleagues, lean into that embarrassment. And when you don't feel like you belong, lean into the pain of that. Instead, I hear too many students respond to fear, embarrassment, and uncertainty with false bravado or destructive defense mechanisms. They may talk obsessively about all the research they're doing or claim to know which residencies are the hardest to get into. Or alternatively, students who are unsure might try and disappear, disengage, or downplay their accomplishments so that when they fail, they can say, I told you so. But we don't have to be afraid of these difficult emotions. One of my meditation teachers said, Your awareness of your pain is not in pain. Your awareness of your fear is not fearful. Your awareness of your anger is not angry. There's a part of you that's spacious enough to hold your experience without becoming it. And it's that part of you that's key to your inner freedom. All of this to say, I believe that thriving in medical school doesn't mean that we have to avoid or gloss over suffering, failures, mistakes, or setbacks. The key to thriving is changing our relationship to all of that, both our own and our patients. It's accepting that we can be present with all of it. It's seeing ourselves as goodish rather than good, so that we might remember that we will never be 100% certain. It's remembering that pain and joy can exist in the very same moments. And isn't that remarkable? So, some take-home points for the day. You're not the only one in your classroom who feels like you don't have it all figured out. And how could you know? I've often compared medical school to childbirth. You can try to explain it to someone else, but no amount of explanation can prepare you for the reality of going through it. Claiming to have it figured out is a defense mechanism that only temporarily protects us from the discomfort of uncertainty that will forever be a part of our experience as a physician. Lean into being good-ish and recognize that if our definition of a good doctor is someone who never makes a mistake, we will never be any better than we are in this moment. Notice when the fear or discomfort of uncertainty is coming up for you. When that feeling arises in my own brain, whether it's fear about getting everything done on my to-do list or doubt that I can care for a critically ill patient in the trauma bay, I say in my head, I can be with this. If you take that very first step to just noticing the feeling, you can shift your belief about what that feeling means. In Irish, I'm told, when you talk about emotion, you don't say, I am sad. You say sadness is on me, which I love, because it reminds us not to identify ourselves with an emotion and to remember that it's only on us for a while, like a sweater we might take off. Finally, hear me in your head. You belong here. This may Not be a felt sense of belonging in this moment. You may have to, for now, simply trust me when I say to you, on behalf of our profession, we wanted you here. We chose you, and you are enough simply and magnificently as you are. In the near decade I have been talking about well-being with medical students, I have learned that not everything I say, not everything that I talk about will resonate with all of my students. There are always a small handful of students in every class who reject the idea of spending any time at all in medical school learning how to be well. But I've also learned to play the long game. My sincere wish is that some point in your life or career, something I've said or something we've talked about today will come back to help you. There's a story in a book called The Age of Overwhelm by a trauma social worker named Laura Lipskey. She recalled an anecdote about a respected rabbi who taught his disciples to memorize and contemplate teachings and place the prayers and holy words on their heart. A day came when one of the disciples asked the rabbi why he always said, on your heart and not in your heart. The rabbi replied, Only time and grace can put the essence of these stories in your heart. Here we recite and learn them and put them on our hearts, hoping that someday when our heart breaks, they will fall in. Thanks for listening, and remember to keep reaching out. Thank you also to Dr. Ashley Pavlik, a friend and colleague, and the course director of the Good Doctor at MCW, who makes space for this content in our curriculum. To Dr. Dave Margolis, the chair of the Department of Pediatrics at MCW, who pays for my time to teach medical students about well-being. To my pediatric emergency medicine colleagues who take exceptional care of kids and of one another. To my family who reminds me that medicine comes second. And to my students, past, present, and future, for keeping me honest always. Finally, thank you to Alex Brown for creating our theme song, Cam Collins for his sound production skills, and to Madeline Sturm for her brilliant art and design work.