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Join Karla Lester, a pediatrician and certified life and weight coach, as she shares her compelling journey from dedicated medical professional to a survivor of narcissistic abuse within the health care system. Karla sheds light on her experiences, the stages of abuse she endured, and the broader impact of narcissistic behavior on health care.

Karla Lester is a pediatrician, certified life and weight coach, and diplomate, American Board of Obesity Medicine. She is founder, IME Community, and can be reached on Twitter @DrKarlaA, TikTok, Instagram @ime_community, Facebook, and YouTube.

She discusses the KevinMD article, “The epidemic of narcissistic abuse in the medical field.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Karla Lester. She’s a pediatrician and a certified life and weight coach. Today’s KevinMD article is titled “The epidemic of narcissistic abuse in the medical field.” Karla, welcome back to the show.

Karla Lester: Thank you for having me, as usual. I appreciate the platform.

Kevin Pho: So Karla has been on multiple times. Go to KevinMD.com/podcast; in the upper right-hand corner there’s a search bar, and you can search for Karla’s old episodes and hear her story. So today, let’s jump right into this one, “The epidemic of narcissistic abuse in the medical field.” How did this particular article come together?

Karla Lester: Well, I have a long history of advocacy. I started a nonprofit in 2007 to address childhood obesity and started working with the children’s hospital here in Nebraska to create a pediatric weight management clinic here in Lincoln. That then led to a population health center, which was my vision, and I moved the assets of my nonprofit to Children’s. During that transition, as I was dissolving the nonprofit and it was moving to Children’s, it was an exciting time, creating this vision for population health, with the Affordable Care Act out at the same time. That’s when the narcissists crawled out of the shadows, started to act and started moving into the stages of the narcissistic abuse pattern. I really wasn’t aware of it. There were signs along the way, and I wish I had had the perspective, and that’s why I’m speaking out now.

Four years ago, exactly, I resigned, per my attorney’s directive, leaving everything I had created there and up to half a million dollars of my nonprofit’s assets that I had brought, and a lot of it was due to narcissistic abuse. As I’ve healed and worked with a coach, I called it out as moral injury and gave names to it. I wrote an article on KevinMD about the gaslighting CEO and the stages of gaslighting, and then I decided I was going to write about these characters. So I wrote about the narcissist Snakeskin Shoes, who was the former VP of marketing and communications at Children’s and who has since gone, after I left. It was really enlightening to learn from Dr. Ramani, on the Navigating Narcissism podcast, about the stages of narcissism. It also helped me, as an advocate, give myself a break for not being able to fix the system, or fix working with this narcissist, and to name exactly what I was going through.

When I wrote the article and published it on KevinMD, I would say it went viral with physicians. I’ve gotten so many reach-outs from physicians all across the country saying, “This is what I’m going through.” It breaks my heart, but I find it really heartening that a lot of these physicians recognize, “This is exactly what I’m going through.” You’re not stuck, and you can decide your next best step, whether it’s to stay, to address the issues, to fight back or to leave, and how to move forward. At the same time, I’m really disheartened and sad, because I believe it’s an epidemic in corporate health care, and it’s even happening in children’s hospitals, unfortunately. We all know it; it’s no secret. But I feel like at this point in time in medicine, there is a community of physicians like me who have gone through it.

Kevin Pho: Take us back to the very first time you felt you might have been dealing with a narcissist. What was that episode like?

Karla Lester: The first time I would have recognized it would have been in stage two, the devaluation stage. The first stage is idealization. There were meetings, and of course it was a huge deal. We’re in Lincoln, and I was, not to exaggerate, beloved here; I had a lot of community partnerships and relationships. They wanted to be in Lincoln, and they didn’t have a footprint here, so what they wanted was to capture my nonprofit and then use me as marketing. So the idealization stage was love bombing, and that’s what physicians are going to experience: “We want you to lead this. We believe in you.” This kind of syrupy praise. Of course we all have ego, and that’s great, but at the same time I had this really powerful vision, and I was like, “Yeah, let’s just get this done.”

Then, once they get you where they want you, well, I had already started the dissolution of my nonprofit, they had the assets and they had my team, and I didn’t get a contract for 100 days. By the way, I had no idea that this VP of marketing, Snakeskin Shoes, as I call him in the article, would have any sort of directive over me. We had an attorney who said, “You need to clarify where you’re going to sit operationally,” so I went to Snakeskin Shoes about that, and he said, “Well, why is he still involved?” I was so fearful that this amazingness wasn’t going to happen and that my nonprofit would go away. Physicians, by the way, be ready to walk, and clarify these things at first. That should have been a sign to me, but it really wasn’t until I got into it. I didn’t have the contract for 100 days, my attorney had to create it, and they were saying things like, “Well, it’s tricky. You’re just different from other physicians.” So I was clued in there. And then Bait-and-Switch CEO, as I call her, who is still there, said, when I said I needed to be paid for the 100 days of work, “Well, what are you going to do with all your money?” So I started thinking, “Wow, this is different.” But I really remember thinking, “I can separate the center. I’m in the community, and I can fully separate it from what’s going on there.”

Kevin Pho: So when you’re dealing with a situation like this, how can you differentiate whether the narcissism is coming from the person themselves, versus whether they have to work through a certain corporate structure that limits what they can do? A lot of these administrative people have to work within a corporate structure, and sometimes that can dictate how they behave. How do you separate those two?

Karla Lester: Well, that’s really tricky. In my case, I had 20 individuals, from the CEO to the board of directors, who were gaslighting me. I literally felt like I was going to die. Physicians are good at defining the problem in front of us, because we have to do that with our patients; otherwise we’re not going to come to a correct diagnosis and treatment. So really take some time to get internal, and on the front end, really define and learn what the operational infrastructure and setup are. It depends on what you’re advocating for. I think it’s really tough, and I got into this: If you’re advocating for patient safety, and you actually have a situation where you know patients aren’t safe or the quality of care is suffering, it’s going to be really tough to find somebody who’s going to support you. I don’t want to say that HR isn’t supportive, but we all know HR is there to protect the organization.

If you can recognize gaslighting tactics, you can recognize the stages of narcissism: first idealization, then devaluation, then the betrayal stage, where they’re actually degrading and attacking you, and then the fourth stage, the discard, where you’re used up, or you’re going to be a real threat to them, and they’re going to get you out. So I would say the most important thing is to recognize whether you have a narcissist in front of you, to recognize those stages, and then, up front, to learn the operational infrastructure. Where do you go? What’s the whistleblower policy? Whom do you talk to if you have an issue? I ran into that issue, too, where it was unfixable. I want physicians to know that you’re not going to fix and solve these people, and you’re not going to fix and solve these systems. Sometimes you just have to make the decision to leave.

Kevin Pho: So you mentioned that when you wrote and shared your story on KevinMD, you got a lot of feedback from other physicians undergoing similar situations. What are some other common scenarios you’ve heard physicians face when dealing with narcissists at their own workplaces?

Karla Lester: There’s a lot of diversity in this, but the experience is due to narcissism, gaslighting and going through these stages. There are some who have been terminated and were really blindsided by it, but when they tell me their story, I’m not, because I would have seen the writing on the wall. I wish they had reached out before, because they were speaking up about patient safety, maybe speaking against a really high-level surgeon who is the top earner and revenue generator and has the ear of the board, and I’m like, “This is not going to end well for you. You’re not going to fix this.”

Then I’ve had others reach out who have had cases of real moral injury, where they’ve sent patients in, like a sick pregnant woman who’s having preeclampsia. They know she’s at high risk, she’s a patient of color, she’s on Medicaid, and they sent her into the ER five times, pleading with them to work her up, and then they didn’t. So it’s a case of misdiagnosis, and she ends up having a stroke and sequelae. It’s this silencing, this not listening. It’s just a nightmare for that physician, and then they are the one who loses privileges at all the hospitals, and their career is totally ruined.

Another time, a physician reached out to me who thought he was on the last run of his career, excited about building a practice. He loves his partners, but there’s one who has a lot of power, who’s the narcissist, and a malignant one, he thinks, and who is really causing a lot of pain. The physician who reached out to me spoke up, had the right to vote and voted against this narcissistic leader, and the leader is making it terrible for him. So he’s asking me, “Should I fight back? Should I give him the cold shoulder? Should I leave and let him win? Or should I hire a lawyer?” He and I are going to be working together, because he asked me to coach him, and I’m glad he reached out, because he’s at the stage where he’s recognizing how unhealthy it is. But it can be really hard when you’re like, “Wait, this isn’t what I expected my career to be. I didn’t go through all of that to go through this.” Because it’s absurd. Obviously, it’s absurd that I’m a physician and a donor at this level, and I’m going through this with some narcissist who’s completely incompetent and knows absolutely nothing about pediatrics.

Kevin Pho: So you mentioned some scenarios and talked about some characteristics that may indicate a physician is dealing with a narcissist, and you briefly alluded to some potential options physicians may have for the next step. What would you recommend as the next step once a physician realizes they’re dealing with a narcissist?

Karla Lester: Well, my thing is to get internal. What happens is that we’re being whittled down when we’re experiencing this. We don’t have the energy to make decisions or to recognize it. We’re showing up, doing a good job, taking care of patients, doing all the work, and again, it seems absurd. So one thing I would say is to have some sort of practice where you have self-care, or you’re writing. And you are not alone. There are so many of us who have gone through this, so you want to create community with people who recognize that humanity in you, people who have gone through it. I’m always open for people to reach out to me, and I can help you and have a phone call, but there are going to be people in your life you can talk to about it, who can give you more perspective on it.

Then you get to decide what you want for your career. That’s the main thing: to know you’re not stuck in it, and that these narcissists are not going to decide your career. They are not going to be any part of your vision for how you care for patients, or for your life. I have a beautiful life. I’m like, “Why am I going through this in the workplace? This is absurd.” I have a beautiful husband, and he’s a physician too, and he didn’t recognize it either; we were both stuck in it. So you’re not stuck. You can have a beautiful life and a beautiful career, but you probably are going to have to leave the situation. You’re not going to fix or solve it. So have some sort of mindfulness practice, connect, write down what you want and decide, and shore up your CV, too.

I also think it helps to create some talking points and some boundaries. Don’t engage in the gaslighting with them. Don’t have meetings alone with these narcissists; that’s like a death sentence for your career there. Try to see whether you have some allies or colleagues within your department who are at your level, who are not just enablers who’ll stay silent and hope it doesn’t happen to them. We need more physicians within these systems to speak up.

As for people who ask me whether they should hire an attorney: I had an attorney who guided different things, like the contract, and they were the ones who directed me to leave. I can’t give any sort of legal advice, but if you do hire an attorney, you have to hire somebody who knows how to work with physicians and really knows labor practices, so an employment attorney who works with physicians. I always think that’s a fine step, and I wouldn’t share with your organization, or with the narcissist, that you’re working with an attorney, because they’ll get you out if you do that.

Kevin Pho: Sometimes leaving the organization isn’t the easiest thing, for a variety of reasons. So how should a physician who’s dealing with a narcissist work within that organization before making the decision to leave?

Karla Lester: Create boundaries with the narcissist: physical, emotional and verbal boundaries. Narcissists really like to have power and control over you, so if you’re not their supply anymore, if they’re not getting anything out of you, that helps. It may be as simple as creating some bully bands. I coach teens who have been weight-bullied, so we create bully bands, like on Post-it notes: just neutral things, kind of non sequiturs. You don’t have to be sarcastic, though I tend to be, but they’re not going to get anything out of you. Also, own your truth. Maybe have three statements ready if they’re coming at you saying something. They don’t control your narrative, so you want to say, “That’s not true. In fact, here’s a factual statement, and we’re going to move forward.” So first of all, there are those boundaries.

Then, as far as deciding, it took me a long time. I was just racked over whether I should leave. I had so much sunk cost in this organization. I was the lead for it, I was going to conferences, and we were launching these big initiatives that have now been killed. You can decide not to decide; that’s a powerful coaching tool. You can decide how you show up. You want to show up confident or calm, and create a thought like, “There’s nothing going wrong. I always have my back.” You can decide that beforehand, before meetings.

When the center went under the CFO, he was this kind of misogynistic guy. He had a meeting with me and called me an “aggressive lady.” I’m a big, passionate advocate for children’s health, so he said “aggressive lady,” and I didn’t like that, because I had met with him alone, and I didn’t like the innuendo of it. He demanded that I have another meeting with him, because he didn’t feel like I was allowing him to talk, I guess. So I got coached, and I decided to show up calm. I was calm the whole time. He had his say, I got through the meeting, and I never had to meet with him again. So you can do that. You can decide not to decide. And I think forward thinking helps: writing down what you want in your career, getting your CV together, and maybe even working with a coach, because that’s so powerful. That way you can really get internal and decide what you want and what your next best steps will be, so you don’t wait until they give you the last straw and you’re like, “No, I’m out.”

Kevin Pho: The scenarios we’ve talked about are between physicians and administration in many cases, but narcissists can also be among physician colleagues as well, right?

Karla Lester: Right. Very true. It’s a big problem, and it’s a big problem for everyone who’s reached out to me and resonated with my article. Among those 20 people, there were definitely many physicians. That can be shocking and very disturbing, and it feels like stage three of the narcissistic abuse pattern, betrayal. You can have betrayal by individuals, and you can have institutional betrayal, like what I experienced. That can be really tough. But I think one of the things is that if you always show up for your vision of how you care for your patients, and for the mission, you will never fault yourself. You can’t fix these other physicians who may be taking part in it. You don’t want to get in their lane. It’s like when somebody’s bullying you: Call them out as a bully, and let them be who they are. You’re not going to fix them. I hope physicians will step up and understand how abusive this is, and that even if it’s not happening to you, and maybe you’re participating in it against another physician because of fear or scarcity, or because they’re a threat to you, it’s going to come for you eventually. Karma catches up.

Kevin Pho: We’re talking to Karla Lester. She is a pediatrician and a certified life and weight coach. Today’s KevinMD article is titled “The epidemic of narcissistic abuse in the medical field.” Karla, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Karla Lester: Well, what I wish for physicians is that you have the perspective I did not have; that’s why I’m speaking up. I want you to know you’re not stuck if you’re experiencing narcissistic abuse. I want you to be able to recognize the gaslighting and the four stages of abuse and get internal. And you can leave; I give you permission to leave if you need to and move forward with your career. You can create talking points that say, “I’m excited about the work we’ve done here together, I’m happy about how it’s going to move forward, and I’m excited about my next best step. You’ll be hearing about it soon.”

Kevin Pho: Karla, once again, thank you so much for coming back on the show and sharing your time and perspective.