The Enemy of Good Is Better

The enemy of good is better.

This phrase keeps coming back to me this week. It swirls around in my brain, and I am unable to get rid of it. I think my mind is trying to remind me why it is so important: in medicine and in writing.

According to my exhaustive research on Google, the phrase was popularized by Voltaire as “Better is the enemy of good.” Eventually the aphorism was adopted in English as “Perfect is the enemy of good.”

Having been pre-med in college and so not exposed to any kind of decent liberal arts education, I first heard this quote in my residency. I was doing interventional radiology, where we use imaging to guide us in doing things like biopsies (taking small pieces of tissue to see if it is cancerous), place catheters to access veins, arteries and other parts of the body, and even to treat tumors with directed therapy. Every once in a while, as my supervising physician was overseeing me working up, diagnosing, or treating patients, he would sagely say, “The enemy of good is better.”

Then he would walk away. I would stand there, scrubbed in, needle somewhere between skin and tumor, and wonder what the hell he was talking about. A few years, and a few patients, later, it made sense.

At the beginning of medical school, you are going to cure people. You are going to stamp out disease and push the boundaries of science. Your idols are people you watch dive into impossible surgical situations, and use phrases like “Hand me the scalpel, I’m pulling this patient back from the jaws of death!”

(Admittedly, these “idols” are mostly doctors on television. It doesn’t matter, though: you are intoxicated by the prospect of joining the ranks of the brave.)

Reality is more complex, of course. It turns out that one of the most critical skills you learn is one only taught by experience: knowing when to accept an imperfect outcome.

This is actually much harder to do than anything else. You start off with your mouth on a firehose of information, trying to memorize it all in time to regurgitate it back for an exam. You commit all sorts of things to memory, with the goal of perfection – a perfect score on an exam, a glowing assessment from a clinical rotation, a unanimously high review on the boards.

What is fed to us all along is this notion that if you keep aggressively intervening, pushing yourself and the people around you, you will achieve better and better outcomes. However, the truth is often there is a point where more intervention has dwindling returns. Identifying that point is critical in medicine, and in writing.

What about the writing process is the most difficult? Is it the creative part? Coming up with the story?

I think it is the point when you realize your work is producing diminishing returns. When continuously intervening on your story doesn’t really get you any further forward. You sit and write something. You rework it, and rework it, and rework it. Maybe you take out an entire character. You delete an interview, a piece of triangulation. You shift this and that around.

At some point, the lack of real progress with the effort becomes apparent. Additions, edits, and cuts are activities but they do not necessarily translate into real productivity. The story never leaves your computer. It never falls into the hands of a reader or an editor, much less a publisher.

This revelation is not liberating in the sense that it frees you from the desire for perfection. I still want everything to turn out well. I still work to try to make sure everything turns out as well as it can.

I have accepted now, though, that sometimes good enough is the best I can get.

photo of Anna in surgical scrubs making a frustrated face
Knowing when you are done is hard.

Leave a Reply

Your email address will not be published. Required fields are marked *