When your medical colleague is a narcissist
Key Takeaways
The medical field may attract people with high self-esteem. Narcissists exhibit increased but fragile self-esteem.
Although narcissism is less common in medicine than in the general population, among physicians, research shows surgeons may be the most narcissistic.
Narcissism can negatively impact clinical decision-making and team dynamics. When narcissists begin to bully, strongly consider reporting them for not only your well-being but that of colleagues and patients.
Nobody begrudges a healthy dose of self-esteem, which is necessary for psychological resilience. In the face of an ego assault, however, people with high levels of self-esteem can exhibit maladaptive behaviors to raise or guard their self-esteem.
In the medical field, such individuals are often preferred in the face of uncertainty or pressure. Nevertheless, these physicians could be perfectly primed for a narcissistic flare-up.
Although this may explain why narcissism can present among physicians, it doesn’t dismiss ugly shows of bluster or associated negativity.
Ultimately, physician narcissism can be a blight on the healthcare system that needs to be adeptly handled.
Frequency
Results from a cross-sectional, prospective UK study found that, compared with members of the general population, physicians are less likely to exhibit “dark triad” traits: narcissism, Machiavellianism, or psychopathy.[] Among physicians, however, surgeons were the most narcissistic.
"Surgeons, in particular, stand out because of their significantly elevated levels of narcissism and primary psychopathy."
— Bucknall, et al.
“Working in a specialty where lives can be saved or rapidly changed for the better demands a degree of self-assurance that allows challenging decisions to be made with cool confidence and prompt action,” the authors continued.
“This is particularly true of vascular surgery, where a ruptured abdominal aortic aneurysm is enough to rupture a hole in most people’s underwear,” the authors added. “Perhaps an ‘essential’ quality in the person specification for recruitment to vascular surgery should be to ‘love thyself?’”
Implications
Results of a survey-based study examined how physicians with increased (but fragile) self-esteem (ie, narcissism) responded to ego threats.[]
As hypothesized, the authors found that narcissist physicians would respond to ego threats by expressing increased self-perceived invulnerability to conflicts of interest compared with their colleagues.
“These results are exploratory in nature, but raise the issue of how motivational factors might, in some cases, interfere with the soundness of physicians’ clinical judgments,” the authors wrote.
"The ways that subtle events that shake a physician’s confidence (eg, a new piece of evidence in a complex diagnostic dilemma) may fail to be appropriately incorporated because of the threat that they may pose to a physician’s ego."
— Alexander, et al.
“Numerous clinical instances abound in which physicians must navigate uncertainty, such as when to refer a patient for a second opinion, when to pursue an additional test, or when to change the course of treatment,” the authors added.
Narcissism probably spells trouble for teams. In a study published in the Academy of Management Journal involving teams of other notable high achievers—NBA players—researchers found that teams with higher average and maximum levels of narcissism, along with more narcissistic players in key roles, were more poorly coordinated and performed worse.[] In comparison, teams that were low in narcissism were better-coordinated.
Handling narcissistic colleagues
Physicians with narcissistic personality disorder (NPD) lack insight and usually don’t ask for help, so they’ll need help from senior physicians and leaders.
They also put patient care at risk, not only by overlooking peer review, but also by creating a negative work environment.
Individuals with NPD are also at risk for suicide—especially if their ego takes a hit.[][]
Narcissistic colleagues can be bullies.[] If you’re being bullied by a narcissistic colleague, experts recommend to:
Try to avoid the bully, but if that doesn’t work, minimize contact.
If you want to lodge a complaint, enlist help from an outside physician, psychiatrist, or psychologist to advocate for you.
Document all interactions with the bully, including conversations, emails, and meeting minutes from meetings.
Seek the support of sympathetic colleagues. Have those who’ve witnessed the bullying attest to it during the complaint process.
Don’t defame your bullying colleague on social media.
If patient safety’s an issue, inform medicolegal representatives immediately.
If your boss is also being bullied, lodge your complaint with their supervisor.
Rely only on facts when lodging a complaint. Don’t get defensive or lose your cool when your narcissistic colleague denies the complaints or attempts to attack you.
Available resources
Doctors experiencing depression or thoughts of suicide have the following support options:
Physician Support Line: A free, confidential psychiatrist-staffed support line for doctors and medical students. 1 (888) 409-0141.
National Suicide Prevention Lifeline: Open 24/7 and offering free, confidential support for all—doctors included—and their loved ones. 1 (800) 273-8255.
American Foundation for Suicide Prevention (AFSP): AFSP offers support for those having thoughts of suicide, people who have lost someone to suicide, those who have concerns about someone’s mental health, and people who have survived suicide attempts. 1 (800) 273-8255 or text TALK to 741741.
PeerRxMed: A free support service that partners doctors with peers to help navigate burnout, resignation, isolation, and distress.
What this means for you
Dealing with a narcissistic colleague can present various challenges. If you encounter such a co-worker, document any negative interactions and report them to supervisors. If a narcissistic colleague is bullying you, seek out the support and help of colleagues. Don’t get defensive or defamatory.