The Perfect is the Enemy of the Good

Voltaire’s “the perfect is the enemy of the good” is about the high-water mark of my philosophical or theological oeuvre. I lack the patience and perhaps intellectual capability to achieve the standards required in those fields. Seeing a glass as 1% empty when it is also 99% full is too frustrating for me.

The famous passage in Theodore Roosevelt’s “Citizenship in a Republic” speech, given at the Sorbonne in 1910, resonates better.

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

Yes, we all know it as the “man in the arena” speech and guess which figure I prefer: the critic or the doer of deeds?

I am drawn to those who are trying to contribute, especially if they are not awaiting permission.  Maybe they won’t get it absolutely right the first time, but they will surely advance the effort and contribute along the way.

Meet Lucy McBride.

She is a practicing internal medicine physician in DC, who trained at Harvard Medical School and Johns Hopkins Hospital.  Her 20-year outpatient medicine practice is founded on the concept that mental health and physical health are intrinsically linked–and that patients benefit most when doctors treat mental and physical health in concert.

Over the last four weeks seeing patients with COVID-19 and realizing the enormous public appetite for medical AND mental health advice from a physician, she has been using her medical voice to help an expanding audience manage COVID-related stress.

A few weeks ago she started sending a daily newsletter to patients, and suddenly they have  gone “viral,” which has thrust her into a more public-facing role, educating thousands of people about the role of mental health in medicine, specifically during the pandemic, and arming readers with fact-based real-time medical advice and guidance on coping with stress, fear, and loss that we all are experiencing.

According to Lucy, “The pandemic is not just a physical health crisis, it is a mental health crisis, too.  It is an opportunity for all of us — and especially doctors who treat the ‘whole patient’ — to raise our voices and help shape the future of healthcare, where mental and physical health are considered co-equal.”

Try her website Try her email newsletter. I am glad I did.

Lots of things are going to change when we come out the other side of this and some of the best ones seem likely to result from those creative enough to explore problems in new ways.

Carry on Lucy. Teddy Roosevelt would have been proud. Heck, he might even have referred to the woman in the arena.


14 Responses to “The Perfect is the Enemy of the Good”

Holworthy '69, April 12, 2020 at 1:43 pm said:

Haven, Great profile. Lucy is one of the best!


Haven Pell, April 12, 2020 at 1:48 pm said:

Glad you liked it. Her efforts deserve attention.


Richard Meyer, April 12, 2020 at 3:09 pm said:

Excellent column by a fine doctor.
As a doctor myself ( orthopedic surgeon), I have often observed in a non scientific way, that patients with certain attributes tend to do somewhat better on the average than others. These attributes include a sense of humor and a religious belief.


Haven Pell, April 12, 2020 at 4:20 pm said:

interesting insights, Richard. Thank you.


Terry Vogt, April 12, 2020 at 3:34 pm said:

I am constantly struck by our medical professionals, and they are showing their merit, gumption, good works (I suppose I could go on a long time), in this time of crisis. I have had the fortune to never have had an operation. I did end up in the emergency room twice last November (bloody nose that came out of nowhere, and a week later a high fever from a biopsy) and I was really appreciative of the treatment afforded me by nurses and doctors. What an amazing group of people. Thanks for letting us know about Lucy McBride, Haven.


Haven Pell, April 12, 2020 at 4:23 pm said:

Thanks Terry. Her newsletters are superb because they focus on practical things all of us can do rather than unreachable things that we can’t.


Ron Bogdasarian, April 12, 2020 at 6:06 pm said:

Mental health = brain health


Haven Pell, April 12, 2020 at 6:36 pm said:

For the record, Pundificator readers, this gentleman is a doctor.


Russell, April 13, 2020 at 11:21 pm said:

What would TR make of a Republic that , while inured to three million deaths a year in the ordinary course of human events, faltered when faced with some thousands more a day for a space of weeks ?

The problem with putting liberty on hold for a hundred days is that might be time enough to forget how much blood it took to achieve, and sustain, it , over the hundred thousand days since the nation’s foundation.


Haven Pell, April 14, 2020 at 11:20 am said:

I wonder if TR would consider how differently we react to new threats than to those we have grown accustomed to over decades. Maybe he would look at the recent crashes of the Boeing 737s and say, “Fifty or sixty years ago plane crashes happened with much more frequency. Since then, safety has become so good that a pane crash is a rare and unexpected event. Perhaps we are now unused to them happening at all?”


Russell, April 14, 2020 at 5:25 pm said:

TR did a bully job of battling the viral epidemics of his day. He led the charge against Yellow Fever from Panama to the fever swamps of the backing Walter Reed ‘s sanitation campaign

Even though the 1853 epidemic killed 6% of the population of New Orleans — 8,000 dieaths, TR did not suspend commerce or the right of public assembly when the disease struck again in 1905.

We are belatedly discovering how severely existential threat inflation has afflicted our popular culture. There seems to be no room in the dismal calculus of the TImes daily death toll maps for global context- readers are left in ignorance of the global context of this tragedy:

Eighty million people died in the year preceding the Wuhan outbreak, and even at the limit of rhetorical overkill , the grimmest models of the virus’ toll fall short for the rate of population growth: there is scarcely any doubt that more people will be alive at this pandemic’s end than at its beginning .


Russell, April 14, 2020 at 6:29 pm said:

Let me add that

1. TR respected the Constitutional limits of his authority that our present chief executive.
2. Liberty is put at greater risk today by the evolving sophistication and ubiquity of surveillance technology:


Haven Pell, April 15, 2020 at 9:25 am said:

I doubt there will be much voluntary “backing off” as called for by the story.

Haven Pell, April 15, 2020 at 9:21 am said:

Russell, I’d like to see a systems approach that began with the epidemic, moved on to the economy and concluded with the long term consequences. One of the primary reasons I began blogging was a fear that debt could prove excessive. Obviously, none of that sort of thinking is possible in an election year, or perhaps ever, given our preferred political process.


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