How do you spot a “psychopath” inside a complex bureaucracy?

It is a consistent feature of bureaucracy. Psychopath doctors and senior leaders almost never get walked out of the building despite years of complaints and truly outrageous behavior. When they finally are fired or brought to justice, just a small amount of digging reveals National-Enquirer-headline-style shenanigans.

Here is the latest in the health care industry press: “Prominent Johns Hopkins physician on leave amid misdiagnosis, bullying claims.”

You can read the details. They will sound familiar.

Multiple comments by pathology physicians and residents stating they did not feel comfortable speaking up regarding “intimidation” or “bullying” behavior by a department leader, indicating they were forced to change diagnoses, issue addendums, and defer to the leader’s wishes over several years, thereby potentially leading to harm to patients.

This is a complete failure of leadership.

They failed to take appropriate actions at any point in a multiple-year history of suspicious, self-serving, and dangerous verbal tirades and actions – all occurring in a health care workplace.

Failing to take action when the code of conduct is broken harms patients, destroys the workplace culture, and burns out doctors and staff.

In our physician burnout coaching practice, one in three doctors must quit their current job and find a new one to recover from burnout. The majority of those job searches are triggered by a psychopath boss.

Early in my coaching career, I worked hard with about six clients in a row, searching for a strategy to dislodge the psychopath – rather than let their behavior chase me out of their job. We agreed on this “one last try” approach. Across those six coaching relationships, we tried a number of different strategic approaches. In each case, we kept at it for 3 to 6 months.

Our success record was perfect — 0 for 6. An unblemished record of failure.

I take that back. We did finally motivate one organization to fire one psychopath for violations of the bylaws and code of ethics. However, my client’s reputation was so tarnished by the effort that she had to leave shortly afterward.

How does this happen?

How does the psychopath manage to defy organizational gravity? There are situations where you witness them do or say something you know you would be fired for, and they get a promotion the next week.

The psychopath superpower

Psychopaths are able to kiss up and piss down the organizational chart with extreme effectiveness. They cultivate sycophant relationships with one or two senior leaders while they target just a small number of people beneath them down the chain of command for their abusive behavior.

If you are a senior leader, here is your red flag:

Whenever anyone comes to you and says, “Dr. X is making my life a living hell, or asking me to do something illegal or immoral,” your instinct is to question that statement. Your inner or outer voice may say something like, “Dr. X? What are you talking about? Dr. X is awesome. There must be some mistake.”

When the complaints are outrageous (like the story at the top of this article) and you immediately deny them without investigating because “Dr. X isn’t that kind of guy.”

There is a very high likelihood you have been groomed by Dr. X, and they are a true psychopath. You are the one this person kisses up to, and he is a very good kisser-upper.

Investigate that complaint fully.

Talk to anyone who was a witness.

Consider doing a 360 survey of Dr. X’s leadership and communication skills.

Here’s the kicker: If our psychopath Dr. X is also a top producer and a big money maker for your institution, and your instinct is to defend them because of their contribution to the profit and loss statement rather than prosecute the behavior, you may be a bit of a psychopath too.

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.