Anyone can exhibit narcissism or narcissistic personality traits or types from time to time in different forms from mild to severe. When doctors are under stress, they can “act out,” or their behavior can worsen. Greater awareness of damaging behaviors is therefore important. The more we recognize the traits in ourselves and others, the less likely they become a problem. However, unfairly labeling or stereotyping doctors as narcissists is to be avoided.

Narcissistic personality disorder (NPD) is different and pathological. It is a diagnosis not to be taken lightly, requiring comprehensive consideration of diagnostic criteria and intensive management, including long-term psychotherapy by a treating psychiatrist.

There are many reasons why doctors with NPD need our help to get help. They lack insight and rarely seek help themselves. The quality of patient care may be at risk, particularly if the doctor is impulsive, overconfident about their capabilities or ignores peer review. A bully with NPD has an adverse impact on the health of their victims and patient safety by creating a negative workplace culture. They can be depressed and, in severe cases, may be at risk of harming themselves if they lose their professional standing or are ostracized by their colleagues when their negative behaviors are exposed.

Notwithstanding the challenges, the damaging behaviors of a bully with NPD, must be called out and monitored by a collective of respected senior doctors or a senior leadership team, rather than expecting individual victims to “muscle up.” Bystanders must speak up. Unless complaints about bullying are dealt with appropriately by medical workplaces, they will continue to be aired through social media, and reported to regulatory authorities. Collectively, good doctors must take responsibility for holding bullies to account and believing victims.

Individual doctors cannot be expected to initiate and endure onerous complaints processes on their own. If you feel you are being bullied, consider enlisting the following network of support:

• Seek regular debriefing from a skilled GP, psychologist or psychiatrist, who understands the irrational nature of the abuse and your inability to “fix” it on your own. It helps if your doctor is independent from your workplace to allow them to advocate effectively on your behalf, especially if you require stress leave or wish to make a complaint.
• First try an early harm minimization approach to the damaging behaviors. If this does not work, try to have no contact or avoid contact with the bully, but if this is not possible, remain brief and always professional.
• Try to enlist the support of trusted people at work, particularly other victims of the bully. Address “splitting” promptly by communicating clearly with others.
• Do your work to your best ability, proactively seek out kind colleagues and stop trying to seek the approval of the bully — nothing will ever be good enough. Do not seek the understanding of the bully or share your vulnerabilities including your distress, as it will be used against you.
• For extreme stress at work, practice “extreme” self-care outside of work — do what works best for you in terms of relaxation and rejuvenation. Stay connected with people you love outside of work.
• Do not internalize the irrational behaviors of the bully and do not waste your precious time ruminating or rehearsing how you will respond at your next meeting — there is no right way to “play” irrational mind games. Instead, spend your time with people who support and energize you.
• Obtain a copy of your anti-bullying workplace policy and follow the correct procedure about making a formal written complaint if this is appropriate.
• An anti-bullying policy will usually recommend documenting the damaging conversations, emails, telephone calls, minutes of meetings or any other objective evidence of a repetitive pattern of destructive behaviors and to make a formal confidential complaint in writing about the bully to the appropriate manager or senior doctor in the hospital, medical service or other health provider. As the support of witnesses and other victims is also important, try to maintain your good relationships with these people.
• During a complaints process, it is your right to have confidential meetings without the bully present, especially if you believe you will be bullied in a joint meeting or there is a power differential between you and the bully. If you have been subjected to bullying, you are entitled to a formal apology as well as reassurance that the bullying will stop and others will be protected.

Also, try to maintain a constructive relationship with your manager/senior doctor to whom you make the formal complaint. During an investigation, anticipate that the bully will deny your allegations and attack your integrity, competence and work ethic. For these reasons, attempts at mediation are often not appropriate. Avoid being defensive, but be ready to calmly counter these unfair attacks when they are brought to your attention. Stay focused on the main issues when you make a complaint, and always use facts and evidence, not hearsay or rumor.

• Remember that your emails, letters and social media posts may be scrutinized by others in an investigation and used against you unless you are always polite and professional. Therefore, never write anything that could be later construed as defamatory or “emotional.”
• If your manager/senior doctor is the bully or is also being targeted by the bully, it may be necessary to submit your complaint to a more senior human resources director, CEO or chairman of the board — if they exist.
• Board directors and CEOs can be held liable if occupational health systems fail and they, therefore, understand and fulfill their responsibilities, which include routinely monitoring staff turnover rates, incident reports, staff and patient complaints and outcomes of exit interviews to identify any problems. But do not prematurely complain at this level unless you have exhausted the other avenues documented in workplace policies.
• If there is a patient care issue, seek medico-legal assistance from your medical indemnity organization in any complaints process to explore all options.
• Enlist the expert advice of experienced legal professionals to address unlawful behaviors.

Endemic medical workplace bullying. Too many people have been hurt. It stops now.

Leanne Rowe is a physician in Australia and is the co-author of Every Doctor. 

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