It is no secret that health care providers shoulder a lot of responsibility. As a whole, they take this on with both competence and kindness. Sacrificially, they go above and beyond in order to provide patients with the highest of quality care. They juggle a multitude of professional and personal responsibilities in creative and admirable ways. Meanwhile, each health care provider learns to adopt a unique combination of coping mechanisms in order to deal with the demands they face on a daily basis.
John Banja, professor, and medical ethicist at Emory University, has focused on studying one of these coping mechanisms in particular — a psychological defense mechanism he calls “medical narcissism.” Health care providers must convince themselves “that [they] can handle any situation — indeed, that [they are] indestructible,” he asserts. No wonder, then, that some health care providers may develop “fantasies of omnipotence” and feelings of “specialness” to cope with such high levels of pressure and stress.
To be clear, Dr. Banja is not proposing that these health care providers are pathological narcissists. Rather, he argues that there is a “peculiar appearance” of narcissistic personality traits among health care professionals — “especially physicians,” he adds. Dr. Banja is not alone in noting this correlation between narcissism and health care providers.
In fact, Dr. Howard Spiro, the founding section chief of gastroenterology at Yale admits, “We physicians are trained in narcissism.” Ostensibly, the development of medical narcissism begins in concert with one’s training to practice medicine.
When health care providers begin their professional training, they arrive with a variety of motivations for choosing that career path, many of which are noble. However, becoming a health care provider can also be compelling for less noble reasons. For instance, Dr. Banja explains that medical narcissists use medicine “as a primary conveyance for affirming [their] worth to the world.” It’s easy to see how the general prestige and sense of respect that comes with being a health care provider can bolster the ego and self-esteem of those who feel like they have something to prove.
Even so, Dr. Banja points out that medical narcissism is also “a form of self-protection.” For example, he asks, “What happens […] when an impressionable, anxious, eager-to-please, developing professional self witnesses grossly unprofessional and unethical behavior toward patients?” Well, usually one’s innate instinct of self-preservation kicks in. Therefore, he adds, “it is easy to see how physicians will come to valorize their own welfare over the very individuals they are duty-bound to care for.” In other words, medical narcissism tends to develop early on as a mechanism of survival.
Even well after a health care provider becomes established in their career, the psychological defense mechanism of medical narcissism remains in place. Many health care providers eventually rise to the top of the hierarchy and find that they are no longer directly accountable to anyone on a daily basis. Unsurprisingly, any narcissistic tendencies or behaviors they may exhibit tend to go unchecked.
Unfortunately, medical narcissism is, by definition, the antithesis of patient-centered care; the psychological needs of the health care provider are prioritized even at the expense of the patient. Ironically, when patients express admiration toward health care providers, they may be unintentionally reinforcing medical narcissism. Due to health care providers’ expertise and the power dynamic that is inherent in the patient-provider relationship, it is not uncommon for patients to idealize health care providers. In some cases, patients may even hope that health care providers will be able to orchestrate miracles. Psychiatrist Allan Berger writes, “The patient’s longing for an omnipotent physician/parent God to save [them] taps into the latent arrogance/grandiosity/hubris of some physicians.” In other words, many patient interactions provide medical narcissists with precisely the emotional support and affirmation for which they are longing. As the patient unknowingly plays into this dynamic, medical narcissism is reinforced.
Inevitably, something will elicit the medical narcissist’s insecurities — their underlying sense of inadequacy, feelings of incompetence, or lack of control. When someone dares challenge a medical narcissist, thereby triggering their insecurities, Dr. Banja observes that they “typically exhibit withdrawal, bewilderment, arrogance, or rage.” These defensive reactions reveal the reality that “hurt people hurt people” — a truth that sits in stark juxtaposition to health care providers’ calling to be healers.
Individual incidents that manifest a health care provider’s medical narcissism ultimately reveal a deeper, more tragic reality — that despite the numerous coping mechanisms that health care providers learn to adopt (regardless of how adaptive or maladaptive those coping mechanisms are), sometimes they are still insufficient. Last year, an NPR story shed light on the disconcerting fact that “doctors are far more likely than the general population to die by suicide.” There are many factors that contribute to this, but one question we must ask is, how can we equip health care providers not only with the medical knowledge and clinical skills they need but also with healthy coping mechanisms? Moreover, how can health care providers learn to adapt to their demanding work environments in beneficial and sustainable ways? On the other hand, of course, perhaps learning to adapt to a system that is so broken is no solution at all.
Shannon Casey is a physician assistant.
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