OCD in high-stakes professions

In some professions, the compulsions look exactly like being good at the job.

For high-performing professionals in Chicago and Chicagoland: This article reflects clinical evidence and direct experience. If you're in the Chicago area or Illinois, contact me to discuss your concerns.

In most settings, compulsive checking stands out. In medicine, law, aviation, and finance it can be hard to distinguish from professional diligence. Double-checking a dose is good practice. Checking it eleven times, then lying awake checking it in your head, is something else.

Where the line sits

Conscientiousness is proportionate and flexible. You check, you are satisfied, you move on. OCD is disproportionate and unsatisfiable. Each check brings brief relief and then the doubt returns, and the threshold for certainty keeps rising.

The telling features are time consumed, distress caused, and the inability to stop despite recognising that it is excessive.

How it often looks

• A physician re-reviewing completed notes or orders well after the shift ends
• An attorney unable to send a document without repeated rereading for errors that are not there
• Intrusive fears of having harmed a patient through an error that did not happen
• Persistent doubt about past decisions and the need to reconstruct them to be sure
• Avoiding responsibilities that trigger the doubt, which then looks like underperformance

The person is often regarded as the most careful one on the team, while privately losing hours a day.

Why professionals hide it

Fear that disclosing intrusive harm thoughts will be misread as danger to patients or clients. Fear of what it means for licensing. And because the behaviour is professionally rewarded, it can go years without anyone else seeing a problem.

Why treatment matters here

Untreated, OCD in these roles tends to grow, consuming time and producing exhaustion and avoidance. Treated, people commonly retain the genuine strengths — thoroughness, care — while losing the hours of checking and the constant doubt.

Published August 2026 · Reviewed for accuracy against the sources listed above.