Medical Narcissism

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By R Carter

You may not know it by this term but we’ve all experienced it, that reaction you get when you question your provider or ask them to provide some kind of proof for why they want do something, or have a particular point of view. Now days, if you’re a CPP then you’ve had enough of this to make you want to throw up on their white coat at the first sign of it.

So how do you spot medical narcissism? Typically it’s exhibited by behavior which appears withdrawn or overly detached, or the provider may react to your questions with bewilderment or puzzlement and in the worst case, they will react with anger or rage, becoming verbally abusive, dismissive or condescending. It’s difficult not to take offense at such behavior, but it’s not impossible. An article by Shannon Casey MD on KevinMD.com gives are very good overview of the phenomena.

Healthcare professionals, particularly doctors, are trained from the moment they enter medical school to behave this way, not intentionally, but because it is a coping mechanism that develops in order to get through the training and the career which follows. A medical career as a Physician, Advance Practice Nurse, Physician Assistant, Critical Care Nurse or others in demanding positions, is such that as many as 6% of students dropout of school before graduating. 24% end up divorced, 10% allow alcohol to adversely affect their lives, another 10% are adversely impacted by drug use and while it’s known the suicide rate is higher, exact numbers are not known. Altogether that’s 50% of healthcare professionals suffering some kind of negative impact due to the profession they practice, which is a staggering number to say the least.

Healthcare professionals are confronted by so much suffering day after day that the only way to cope emotionally is to become detached. Care too much and they begin making judgements based on sympathy rather than empathy. Do so and medical mistakes soon follow and lives are put at risk. These kinds of careers are not just hard on the individuals; they are hard on the spouses and children as well. In my own case, I had hoped both my children would follow in my footsteps. I  made it possible for them to get a summer job in the OR with me, so they could get firsthand experiences at what it was like to work in surgery and manage a demanding anesthesia obstetrics practice. Only to have both tell me afterwards that they had no interest. When I asked why, they both said it was because I was away from home too much and missed too many family events. That’s some guilt I still carry today, and though I rationalize that I was giving them a better quality of life, the pain remains because money can’t buy happiness.

I know from my own experience, five years into my career my wife began commenting on the crass and gross manner of the type of jokes I would tell. An indifference to the pain and suffering of those I cared for. Once pointed out, I recognized her assessment as correct, I had changed and didn’t know it, plus I knew of no solution for it. Without that detachment, I would not be able to remain cool and calm when an individual was wheeled into the OR with no legs, having lost them in an auto accident while getting his knob polished by his partner, she died in the accident.

It takes a conscious effort to be empathetic and for that reason, not every individual is willing to make such an effort, worse yet, like me, they may not even know they have slid down a slippery slope. Medical practice is so highly specialized; that once mastered it’s as much of an art as it is a science. How many successful artists do you know who don’t take criticism of their work personally? Your identity becomes so entwined with your profession that the two are indistinguishable.

So as a patient how do you respond to medical narcissism when it hits you square in the face? Well I can assure you, striking back is a no win strategy. The provider always has the upper hand and can refuse treatment unless you are facing a life threatening situation. Rationalizing with them is also unproductive, most of the time those who remain narcissistic do so despite having been confront by their peers. So you have no chance of changing the self-portrait they have of themselves. If your personality and disposition is such that you need a compassionate and caring provider, it’s better to simply keep looking until you find what you need. It may help to know that these types of providers are the way they are because they too have been damaged by the very profession they practice. That’s not an excuse for their behavior but some basic knowledge you can use to adjust your own expectations on how to respond for your own benefit.

Getting insulted, dismissed or verbally abused hurts, and giving some back may make you feel better for a short time, but it will not help you get your healthcare needs met. Better to recognize the symptoms and have your responses prepared in advance so you can get your own needs met. Kick the dust from your shoes and move on down the road.

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