more_vert
HOW is it possible that endemic bullying (here, here, here and here) persists in medicine despite a Senate inquiry, viral social media campaigns, doctor education, incident reporting and other initiatives to improve awareness, mutual respect and medical culture?
In some cases, we can blame health systems issues, such as medical workforce shortages, lack of funding and unsafe hours, but in other cases, we must take collective responsibility for failing to hold individual doctors to account for their damaging behaviours.
Most doctors readily change after being counselled about poor social skills, rudeness, bullying, sexual harassment, discrimination or racism. But others refuse to accept they have a problem, and risk damaging their reputation, position, career or, in a recent case, their accreditation. Why would doctors do this? And why is it so difficult for others to call them out and intervene effectively?
One of the reasons may be due to narcissistic personality disorder (NPD), which occurs in up to about 6% of the general population. In my experience of working in clinical and board leadership roles across many different medical workplaces for nearly three decades, doctors with untreated NPD may manifest bullying behaviours in a number of ways.
Fundamentally, a doctor with NPD is arrogant, feels entitled and believes others have a problem. In subtle or not so subtle ways, they let other colleagues know they are “special”, exaggerating their exceptional skills in patient diagnosis and management. Patients often adore them as they also inflate their achievements in their consulting rooms, while making derogatory comments about the clinical management of other doctors.
Consequently, a doctor with NPD may seem charming on the surface and have many admiring followers. Generous one day and dismissive or aloof the next, they justify their quick temper as necessary to keep other doctors on their toes and to uphold a high standard of patient care.
To avoid being reported, doctors with NPD may slowly undermine their victims with repetitive nit-picking and sarcasm, drip feed low grade abuse that is difficult to call out, avoid eye contact, roll their eyes with disdain when no one else is looking, or give out backhanded jabs dressed up as jokes. Intermittent stonewalling and private taunting are also tough to prove.
It is particularly difficult to call out an employer or supervisor who has NPD, as on the surface, they may appear to be trying to help their victim. In reality, they may be quietly investing their time into their subordinates for “a return”, exploiting them financially, expecting them to work unreasonable hours, taking credit for their achievements, performance managing them unfairly, focusing on their vulnerabilities with patronising concern, or making veiled threats about job or training security to keep their victims in their place.
Nothing is ever good enough, which creates excessive fear in the workplace, paradoxically reducing the performance of other doctors and endangering patient safety (here and ). Others find it difficult to challenge the doctor with NPD as they twist words, misconstrue situations, or are easily slighted by routine peer review, constructive feedback or minor criticism.
More severe behaviours of NPD include pathological lying, nasty competitiveness or smear campaigns against other people. This often occurs without the knowledge of victims, who are unable to defend themselves against false rumours because they are the last to find out. The falsehoods often focus on what hurts doctors most, for example, being accused of failing to pull one’s weight, a lack of integrity or, worse, incompetence.
When confronted, the bully lacks empathy and may pretend nothing has happened. To maintain their superior status, power and control, the perpetrator may also play the martyr or accuse a victim of being toxic, dishonest, mentally unstable or “not up to it”, which causes further harm. A doctor with NPD is often quick to threaten legal action for defamation while continuing to spray lies about others, which is a very effective way to split people. As a result, the complainant is sometimes wrongly accused of poor behaviour, rather than supported by others in the workplace.
A common myth assumes victims of bullying are oversensitive, weak individuals who are unable to stand up for themselves. More often, bullies target high achieving victims who they envy. When a target lacks boundaries in relation to self-protection and self-care, they try to appease and tolerate the bully for too long. The mind games are irrational and there is nothing the victim can do to “win” or fix the situation when the rules keep changing. Any individual intervention only makes matters worse while the perpetrator continues to enjoy “playing” with their victim.
In response, victims naturally become upset, hypervigilant and defensive, and when their stressed demeanor confirms the doubts of colleagues about their mental health, they may gradually lose their support network. Recommending self-care strategies, resilience training and cognitive behavioural techniques in this situation can be harmful because further responsibility is placed on the shoulders of the victim to change, but this doesn’t stop the bully’s destructive behaviour.
Change is also difficult because doctors with NPD usually don’t regard narcissistic traits as negative as they feel superior to other doctors and often say so directly or indirectly. Witnesses fear getting involved for fear of becoming a target themselves and remain silent when it appears “there are always two sides to a story”. In some recent high profile cases, hospitals, medical services and other health providers have turned a blind eye to bullying, particularly when doctors are senior, generate healthy incomes or have skills that are in high demand in an area of workforce shortage.
With all these challenges in mind, how can we hold bullies with NPD to account?
Greater awareness of damaging behaviours is important. 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 behaviour can worsen. The more we recognise the traits in ourselves and others, the less likely they become a problem. However, unfairly labelling or stereotyping doctors as narcissists is to be avoided (here and here).
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 ostracised by their colleagues when their negative behaviours are exposed.
Notwithstanding the challenges, the damaging behaviours 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 Work Safe authorities, the Fair Work Commission, the Australian Human Rights Commission, and in a recent case, to Parliament, to the detriment of all involved.
Although I have written previously on the high threshold for mandatory reporting to the Australian Health Practitioner Regulation Agency (AHPRA), which is rarely met for doctors with mental illness, severe NPD may be an exception if patients are placed at substantial risk of harm. In this extreme scenario, the notification should be undertaken by a group of respected senior doctors, and only after expert legal advice to ensure notifiers have statutory protection from legal action. Unfortunately, if all else fails, it may take an intervention by the Medical Board to ensure the doctor with NPD attends regular psychotherapy as part of restrictions on their medical practice.
None of this is easy. However, we should never allow the damaging behaviours of a doctor to reach this level. 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 minimisation approach to the damaging behaviours. 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, practise “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 internalise the irrational behaviours 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 energise you.
- Obtain a copy of your antibullying workplace policy and follow the correct procedure about making a formal written complaint if this is appropriate. If your workplace does not have a policy, access information about routine complaints processes on the Fair Work Commission and Safe Work Australia
- An antibullying 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 behaviours; 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 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 any 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 rumour.
- Remember that your emails, letters and social media posts may be scrutinised 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. Whistle blowing policies apply in this situation.
- Under the Fair Work Act, board directors and CEOs must ensure that effective occupational health and safety policies are in place, outlining non-compliance penalties and the use of just and fair disciplinary processes. Board directors and CEOs can be held liable if occupational health systems fail and they, therefore, understand and fulfil their responsibilities, which include routinely monitoring staff turnover rates, incident reports, staff and patient complaints and outcomes of exit interviews to identify any problems. However, 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 organisation in any complaints process to explore all options. Also seek their advice if it is appropriate to pursue a complaint to regulatory authorities, including AHPRA when patients are at substantial risk of harm.
- Enlist the expert advice of experienced legal professionals to address unlawful behaviours.
- Continue to debrief with your independent GP, psychologist or psychiatrist regularly. It is not humanly possible to endure a complaints process without regular mental health care outside your workplace.
Endemic medical workplace bullying. Too many people have been hurt. It stops now.
Clinical Professor Leanne Rowe AM is a GP, and co-author of Every doctor: healthier doctors = healthier patients. In the past, she was Chairman of the Royal Australian College of General Practitioners Council, Deputy Chancellor of Monash University, non-executive Director of beyondblue, and acting Chairman of Barwon Health. All views are her own.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless that is so stated.
If this article has raised issues for you, help is available at:
Doctors’ Health Advisory Service (http://dhas.org.au):
NSW and ACT … 02 9437 6552
NT and SA … 08 8366 0250
Queensland … 07 3833 4352
Tasmania and Victoria … 03 9280 8712 http://www.vdhp.org.au
WA … 08 9321 3098
New Zealand … 0800 471 2654
Medical Benevolent Society (https://www.mbansw.org.au/)
AMA lists of GPs willing to see junior doctors (https://www.doctorportal.com.au/doctorshealth/)
Lifeline on 13 11 14
beyondblue on 1300 224 636
beyondblue Doctors’ health website: https://www.beyondblue.org.au/about-us/our-work-in-improving-workplace-mental-health/health-services-program
Loading ...
Having just been the victim of a smear campaign by a doctor who I now realise is a covert narcissist; I can completely relate to the horrific experiences and suffering others have gone through. These people are poisonous to the hearts and souls of the healthy, the empathic, and the kind. Thankfully as a short term locum, I was not around this individual for very long, but true to form, after I left the post[ i found out that he had made an unfounded and malicious complaint. This initally floored me emotionally as the smear was completely undeserved as well as being untrue. Reading this article has helped tremendously with regards to reframing this behaviour as bullying, which I had not seen or understood before before; having previously accepted the subtle the digs, controlling demeanour, along with the meaness to others and constantly walking on egg shells as ” just him”. Thankfully being in the uk at the moment, what also helped was completing a 360 multisource colleague feedback as part of the parallel process of preparation for revalidation. Not knowing that this doctor was going to attempt to spike my career, I inadvertantly included him as one of the referees. When I got the annonymised results, his malicious input was glaringly obvious and at complete and utter odds to the 100% positive feedback and praise that I had recieved from the rest of the team. Thankfully I now have evidence of his psychological dysfunction in writing. This is a strategy I will definitelyuse again, if I ever again get even the slightest hint that I am working with a narcissitic boss.
Develop your mental ‘detached observer log’ for the speech, events etc. This makes it easier to make an actual log of events and coercive speech without flipping into victim state.
Notice the drama around you, stay cool and humble.
Admit your own mistakes/weaknesses easily and simply.
Give them some sincere positive feedback to antagonistic types.
Have a look at ‘Brook Gibbs’ Ted Talk on bullying.
We need our younger and good hearted Doctors and specialists in good health and spirits to deal with systemic problems in the health system and to help Australia respond to a changing world.
Thank you for this article. I spent several months working alongside a specialist surgeon — then spent the next two years getting treated for symptoms of Complex PTSD. The bullying behaviors from the surgeon and his “fan club” had been subtle, but they were relentless. I had eventually reached out to management for support, and ended up losing my job. The subsequent smear campaign was significant, and was effective in convincing my peers that I was mentally unstable, which allowed the perpetrators to escape all accountability. It’s been a long road back to normality and healthy functioning, but I will never be the person I was before. The internal scars are permanent. I am truly sorry for any other person who becomes the unsuspecting target of any disordered individual.
I googled “prevalence of narcissism in the medical profession”, after dealing with two particularly NPD gps in a row. And found this- and thank you so much. I have been in the fight of my life, and have complex health issues, and was systematically emotionally abused (gaslighted, minimised, dismissed, moving goal posts) by two male gps I went to for health support. I have also been googling one of my conditions and seen how many other people have had this experience, which as bad as it sounds, helped. I came to believe that medicine attracted those on the narcissism spectrum looking back over the course of my life’s history. I believe a big public expose on what is occuring, education, and an independent tribunal for complaints is completely warranted. Unfortunately, as a patient, if you suffer this type of abuse, it is very easy for the doctor to say that you have a severe “problem”, exactly the hierarchy you address. This redundant model really needs to be tackled. It has occured to me these practitioners have put themselves in this position because they can deal with the vulnerable, which sickens me. I found that just asking questions triggered rage, then they each tried to bait me, but I stayed calm. But I have knowledge and life experience. There are those for example who accept abusive behaviour as normal (I don’t) who would just go along with it. I have thought about the other staff- do they “walk on eggshells”? I have found myself wondering what purpose their behaviour achieves, how on earth can that make a person happy. That’s the overthinking you should not do- it’s their issue, back to the basics of NPD, phew. And just, thank god I am nothing like that.
I have just been through five years of false allegations about my clinical work. I survived to reach retirement. I still have nightmares and flash backs, but they are settling.
The answer will not be to change or train the doctors with NPD. They think they are fine and so are resistant to any counselling.
An alternative answer is to abolish the hierarchy within medical regulation. Decisions about doctors capability can be made by their peer-group who should be chosen at random from around the country. This will avoid the concentration of NPDs who can be found climbing the management ladder.
Narcissists seek out a hierarchy because the power gives affirmation to their fragile ego. If the hierarchy is removed then they go elsewhere. The challenge is not to change the fallible NPD humans to be “less human”, but to change the system so that it still works with fallibility. That is the message of “safety” and it applies here.
The advice given above on what to do appears to be to out-do the narcissist at their own game. e.g. form a group, gather lots of little snippets. The narcissist has built their life on doing this and has delivered the first blow. Any response to highlight their wrongdoing comes across as sour grapes. I suggest one moves away from the narcissist if possible and if necessary gets assessed completely independently.
Your article describes my experiences perfectly, right down to the institutional response, so much so that I was wondering: “When was she here? I don’t remember there being a visitor in our unit.”
Do you have any suggestions, or can you point to resources, for responding to the indirect, belittling commentary dressed up as “concern for patients”? Questions like: “So now we’re operating on asymptomatic patients are we?” or “Tell me *exactly* how you will do that operation?”, where the meaning is not in the words but the tone of voice and body language that says: “You are such and incompetent human being you shouldn’t even run a garbage truck.”
Actually Susan, brain surgery IS rocket science.
Neurosurgeons are at the sharp end all the time. Which is why they burn out at 55.
And no, I am not one, and couldn’t do what they do, even though I have finely-honed skills at my sharp end. So I am somewhat forgiving.
“Anonymous” 34 claims “You can’t, for example, go toying around in someone’s brain like a neurosurgeon does day after day without an enormous amount of self-confidence.” Brain surgery isn’t rocket science. All branches of medicine require finely-honed skills at the sharp end – whether they are counselling a suicidal teenager or resuscitating a patient with airway obstruction. The best clinicians in every specialty – procedural or non-procedural – act thoughtfully but decisively. As humans, though, we can all become stressed and lose our tempers when the circumstances provoke us. The key is to work to avoid outbursts and also apologise afterwards, not to use our particular specialism as an excuse.
Great to see yet another article about organisational dysfunction in medicine. Sad to see another article about organisational dysfunction in medicine.
A senate investigation did not change the behaviour and structure of the national regulator (AHPRA), which sets the standard of behavoiur within the healthcare industry. Why not! Largely because multiple organisations did not step up to the plate of demanding change.
Of course you will be able to point to individuals who behave badly or provide episodes of bad care, but blaming individuals rather than fixing the system that supports them will not make healthcare safer.
That we need to have another article about the an unsafe healthcare system is why Healthcare Excellence Institute Australia exists – designed to counter the dysfunction with research that proves the dysfunction. We have to break the current paradigm. To that end, on the 13th April, I will speak on MOBBING, not about individuals behaving badly, but institutions allowing bad behaviour toward someone prepared to stand up to the bullies. AHPRA has become the tool of the bully, as have other organisations.
The full program for the Melbourne meeting is at http://www.healthcareexcellenceinstitute.com.au; bookings via http://www.trybooking.com/bahna.
So relevant – too late for me – a NPD and a bullying complaint – was turned against AHPRA smear campaign was followed which destroyed me – sometimes it’s better to grin and bear it
Having experienced this type of bullying in a practice I worked at as a contractor a long time ago, I was unaware of the severity of the effect it had on my health until I finally chose to get out and go elsewhere. I had a chronic physical illness and my health improved significantly and I no longer had thoughts of dread and palpitations when I had to go to work. Thanks for an excellent article which also gives great advice regarding management of oneself in these toxic places. I have had the pleasure of working in a practice for the last 11 years where everyone works for the patient and works as a happy team.
In response to Dr Pardy, with respect I think you miss the point. Your case illustrates a high stress situation in which emotions run high. The lack of response from the paediatric registrar to your questions is understandably annoying, but as seniors our job is to keep our cool, and not respond from an emotional space. Good professional communications should not be transactional (“if someone ignores or annoys me, I will therefore respond aggressively”). As a human your response is understandable, but as a senior specialist and team leader I would suggest it is less than ideal. Asking “Do you think we do this for the sport of it?” is aggressive and unsetteling, and does not generate the environment or clarity of mind in the paediatric registrar conducive to good resuscitation.
As you have asked for evidence, see: https://pediatrics.aappublications.org/content/139/2/e20162305
In this paper, rudeness was associated with a marked redction in team performance in exactly this clinical scenario.
We all fail and have our bad moments. But we have a duty to recognise when we are wrong, reflect and constantly improve.
Best,
Scott Parkes, Director of Intensive Care, Launceston General Hospital
The problem with this article is that it’s still written in the ludicrous belief that senior doctors, administrators or Colleges will somehow tackle the bullies once you inform them about it – the reality is that more often than not it’s the senior doctors, administrators and Colleges that initiate, support and cover-up the bullying and the bullies.
What’s the answer to that problem?
Thank you for your useful article Leanne.
I have a female colleague who certainly has NPD. I have learned a lot about it recently and wish I had known “then” what I know now. We have a complaint from a sub contractor and are trying to manage this . The bullying can be subtle and done from her point of view for the benefit of medicine!! and so is justified. When her behavior is called out she becomes very hostile and turns it all around on us. I do not know if she deliberately plans it or if it all comes naturally to her. Probably the latter: put downs, derision mixed with false praise pour from her mouth as soon as it opens.
Leanne,
Well done !!
A fine article.
I could write a book about the subject.
The medical profession is full of narcissists …
and as a retired FRACP … and the child of a doctor …
I feel these cancerous carbuncles of the profession should be hounded out of our public
hospitals … or wherever else they hide like the pathogens they are … weakening
the structure in which they function. That might mean a loss of 10% of the profession!
A rough estimate from many years of doctor observation (plus my late father’s observations).
I’ve had the misfortune of meeting dozens of them. They’re like poison.
My experience of ” FRACPs in training” is that the vast majority are of the very highest quality … people to be valued like the rare gems they are … just look at their academic records … the cream of the cream …
and a small minority … only just older … with NPS (and other assorted personality disorders) can wreak havoc on these young doctors. I knew of one colleague / and a friend of mine …
( we went through medicine together as undergraduates … and I’ve never met a kinder sweeter AND QUALIFIED young lady … but she was bullied by a surgeon and was so traumatized, she walked away from medicine … WHAT A TERRIBLE WASTE! AND INEXCUSABLE!)
give up medicine in their 1st of 2nd year because of the bullying they received
and if mistakes are made … and I’ve/we’ve all made plenty … it is very simple for a compassionate senior doctor who looks in the mirror occasionally … to make the error a positive learning experience … and for those who whine that “lives can be lost / a rocket up their … does them some good” …
please cease and desist … we are all doctors … we all know the consequences of our errors …
But to these poisonous NPS characters it is not about mistakes … it is about POWER and the abuse of it.
Errors (medical or others) are just a good entry point for these NPD personalities.
and fortunately the vast majority or errors are minor due to the high quality of our trainees and the systems (imperfect though they are) in place to keep the errors minor … very rarely are mistakes made that threaten life. Just compare the number of interactions/ consults/ treatments, with the life threatening errors … the figure must be in the one in 10s of millions.
I’m sure there is a statistical figure out there with an approximate answer.
Our “training / junior” (I hate these terms) doctors … our fully qualified (MBBS) doctors in their 20s/30s … are
treated like dirt in hospitals and the worst offenders, of course, are their NPD seniors …
and I discovered it doesn’t stop (of course it doesn’t stop) when one becomes a consultant.
The public hospitals are an endless rat race for those interested in climbing the greasy pole of subspecialist/ bureaucrat / staff specialist. Unfortunately, as one sees so often, a doctor has climbed to the top of the greasy pole … but he remains a rat.
I’m afraid a small minority (but perhaps 10%) of my colleagues strut around the wards like the repulsive
tin gods they are. Some even have the audacity to think they should be paid more the older they get! As the alcohol
and cerebrovascular disease diminishes the quality of care they give.
TRUE PUBLIC SERVANT mentality! When their younger peers run rings around them … all that medicine they’ve forgotten…
apart from the rare occasion when the, usually geriatric physician / surgeon, ( surgeons are the worst of the medical narcissists and the most prevalent) … the poor old guy remembers seeing a case of a rare condition 50 years ago … that no one under 70 has seen … hence the “sense of entitlement” that they deserve more pay than their younger and harder working colleagues. “I’m more experienced” they whine … well I’d rather have a 45 year old rather than a 65 year old looking after me.
A pox on all narcissistic doctors … you are a disgrace to a noble profession … and if I had my way … you wouldn’t have a job in our sadly declining medical system (a Ponzi Scheme if ever I saw one).
Power Corrupts. Absolute Power Corrupts Absolutely.
Alas with the parlous state of our profession I know nothing will change. So very sad to see the decline of our public hospitals … when we could easily have one of the finest healthcare systems in the world. As my late father said decades ago … “I fear we are headed towards the disaster of the UK NHS” in which he worked for some years in the 1950s.
Narcissists and psychopaths are rife in psychiatry and health regulatory organizations.
I have come across a very disturbing story.
A gp started consulting with a psychiatrist as a medical student at age 21 for social anxiety and low self esteem issues. This male psychiatrist about 20 years older treated her in the most cruel and inhumane way with psychological abuse leading to suicidal ideation. After an attempt and still a student sexual misconduct commenced and continued for about 12 years. She was entrapped in a Stockholm syndrome type situation with him for about 25 years in total before she was finally able to escape and receive appropriate treatment. She was finally able to make a notification to ahpra which took 4 years to get to vcat. The case was presented on the sexual misconduct alone. She was extremely protective and loyal to him due to the extreme psychological manipulation and so it was a he said/ she said scenario and the case was found not proven because he denied and lied and perjured himself. Hence this psychopathic psychiatrist is free to continue to practice.
What is the point of mandatory reporting? It relies on people having some conscience and ethics to admit to inappropriate behavior otherwise unless there is some hard evidence true psychopaths will continue to get away with the most egregious behavior .
Document everything and put your own needs first. The regulators are not interested in protecting the public and the narc/psychopath will always only be looking out for themselves.
Timely article on a perpetual toxic topic, as witnessed by the many written responses.
Interesting to note that the recommendations are all focusing on how the innocent victims of bullying can change their behaviour and experience.
Very little recommendations on what institutions, directors and managers can do, even though they are the ones who are ultimately responsible for such bullying and narcissistic behaviour.
Sounds like yet another recommendation to develop more resilience while the system that props up bullies, narcissists and nasty bosses remains unchanged.
You can’t, for example, go toying around in someone’s brain like a neurosurgeon does day after day without an enormous amount of self-confidence. Is that narcissism? Is that a disease entity in the DSM (certainly would be under the new American PA guidelines)?
And your description, Leanne, strays into psychopathic rather than just narcissistic PD. Both are notoriously resistant to ‘treatment’.
Great article, thank you!!!
12th March, 2019.
Please attend the HEIA symposium being held on Saturday the 13th April. 2019 at the Radisson Hotel…
if only because Rae and Damien PANLOCK [the parents of their daughter Brodie who committed suicide from bullying]… and they then, instrumental in Brodie`s Law Victoria..
Rae and Damien will be speaking from the podium… and, an opportunity ” not to be missed ! ”
Other excellent speakers panel highlighting the issues…
See the program at http://www.healthcareexcellemceinstitiute.com.au
Well written and truly reflected. One with non-Anglo appearance and name will be suffered most.
Men in medicine are the main perpetrators. I have encountered this phenomenon countless times and in three teaching hospitals. It is ignored by administrators who do not know how to deal with it. NPD is destructive in the extreme. I consider myself a survivor of endemic bullying by male doctors with NPD, but at great personal cost.
If I could live my life over again I would choose not to go down the same career path. I could write a book about my experience but without a happy ending.
Thank you. Having endured a NPD senior doc as my boss – bullying became normal and was a very long and involved process which did result in the bully doctor being removed but it took 4 years. The hospital was slow to provide support. Fortunately the CMO eventually got involved. A long hard road with long term stress and anxiety issues. I wish I had resigned instead. It was not worth .
I worked for a GP who certainly ( in hindsight ) had at the very least, Narcissistic personality traits, if not the outright disorder. Sadly I was married to one as well, gaslit at home and at work… lucky to have survived ! Unfortunately, these people tend to protect themselves well. I wish I’d had the list given above, to deal with either of my Narcissists ! Fell over laughing when I read ” A doctor with NPD is often quick to threaten legal action for defamation while continuing to spray lies about others, which is a very effective way to split people ” my ex is still out trying to sue anything that moves and has money. If you find yourself at the wrong end of one of these people, learn how to play with a flat bat, give them nothing, noncommittal comments, nothing personal – grey wall them . They will eventually leave you alone, and find something better to play with.
What can the victim of bullying do when the bullies are the head of department, executive director, and board members? With their collective persuasiveness, bystanders like human resource manager, MDO lawyers, counsellors etc may find it ‘threatening’ to take on these highly influential bullies and may take on the easier approach to collectively influence the victim to accept guilt and more humiliating disciplinary action like ‘educational’ undertaking, career restriction, condition, resignation / dismissal etc. The victim will have no hope of receiving any fair treatment and their dream of achieving more in their career will come to an abrupt end. That’s why so many victims of bullying are severely harm and our regulators are still in denial or merely paying lip service.
I fully agree & support Prof Rowe’s call to stop this endemic bullying now. But how can this be stopped when these bullies are holding very influential position and enjoying ‘elite’ status with ‘immunity’?
Agree, more commonly noticed in regional/remote areas I assume. Long unpaid hours and not giving any support/positive feed back to hard working doctors is quite usual too.
At last the elephant in the room is being mentioned. For years I have advocated that forensic psychiatrists and psychologists be employed in HR to investigate bullying and even then, intelligent NPD’s will be difficult to identify and may still con and manipulate the theoretically trained investigator.
For the victim trying to convey to inexperienced HR personal, it becomes a massive and distressing endurance feat to explain the behind the scenes bizarre manipulations, lies and deceptive behaviours. By the time the victim seeks help, they will more then likely be “crazy-made” and barely functioning.
Bystanders do rarely speak up and for many reasons a) they do not see or are one of the “flying monkeys” of the NPD person b) they fear for their own safety/job/position c) they become complicit to behaviour that they are historically used to seeing. d) denial/rationalisation etc
In short, Health department HR as we have now are not equipped to manage personality disorders.
Good luck trying to achieve anything with compulsory psychotherapy. The most likely outcome is manipulation of the therapist.
actually I’m not narcistic I’m God like.
Leanne
many thanks. it is my experience as a leader in an industrial organisation that many issues in hospitals arise from serial malignant NPD doctors. how to resolve? very difficult, as NPDs are expert at charming the bosses, and once employed, very very difficult to do anything about them.
Tony
I was unable to find high quality literature on prevalence of NPD in different medical specialties other than the attached refs. Would be interested if others know any.
This is great advice Leanne. Sadly there will be few who feel empowered enough to follow this through. In particular most doctors in training will not wish to be labelled as “troublemakers” or to “rock the boat” as this may impact on their access to training programs or their success within a training program. Most doctors will only act if there is a risk to patient safety and even then we know that incompetence is often ignored for far too long.
Unfortunately those who are victims of someone with NPD often lose all self-confidence and are so disempowered that they are unable to do more than survive and hopefully “escape” the situation.
To deal successfully with bullies, especially those with NPD, there needs to be a culture change and collective action at a senior level to call out bullying behaviour when it is observed. Senior medical staff and hospital administrators need to look beyond the charm and medical skill and identify individuals in units which are not functioning well – staff turnover, sick leave, incident reports etc are all signs of dysfunction. Doctors in training need to stand together and call bullying out when they observe it. The nursing and allied health staff need to be prepared to call out behaviour, report it and back up those who are impacted. Also as you suggest the individual with NPD needs help to access appropriate expert treatment as they lack insight.
I am currently pursuing legal action against a GP Medical Centre for a peremptory dismissal that followed me making a complaint about the sort of behaviour outlined above.
As an associate GP / sub-contractor I seem to have very little in the way of support. It is also just as well that I am happy to retire relatively young as I cannot see me being very popular in this area. Medicine is a very small world, and the offender has friends.
I am so glad someone has finally written about this longstanding problem in medicine. As doctors we have often joked about it when expressing our frustration about certain circumstances.
However, it’s almost as if we have been afraid to make the diagnosis which is so obviously clear to us. It is also very difficult to prove and handle this kind of bullying when it is done by a shrewd narcissist. It seems very subjective and ends up you-said-they-said. Especially if it is a senior colleague with lots of admirers.
I hope this article will highlight this problem, bring this issue into the foreground and get more people talking about it.
I do agree that the percentage appears to be higher in the surgical specialities.
I think the narcissistic personality tends to gravitate toward the surgical fields where people have to answer to their beck and call and serve them and where they can bask in the glory of a “successful procedure done in record time”
But no doubt they are present everywhere and are usually highly intelligent and skilled in their game playing.
A point to remember is that a narcissist is really a very deeply disturbed person with severe anxiety issues and although it may not look like it, significant self-esteem issues.
The one thing they can’t stand is being ignored.
junior staff are particularly vulnerable
NPD / Pyscopathy / Sociopathy all titles for a family of abnormal behaviour. My understanding is 1 in 95 children by age of 4 do not develop normal levels of empathy required to function as part of normal society.
These individuals may be academically very bright, but the just do not GET why putting others first is in any way better than serving ones own self interest. They’ve generally learned right from wrong as an imperative survival skill. However, if it doesn’t serve their own ego or best interest they cannot be relied upon to do the right thing, ever. The cannot see the logic in it.
It is thought that by the time they achieve a high position in any organisation the ratio to normally adjusted people is closer to 1 in 6.
Job oriented, overly heightened sense of self worth and unable to see the subtle benefits of normalcy.
* Suggested reading ‘Taming Toxic People’ by David Gillespie, who makes the point that if you gave this book to a NPD type personality, they would not be able to see themselves in the book.
QED.
NPD:
6% of the general population
20% of doctors
40% of proceduralists
70% of College/AMA presidents
97.6% of presidents who go into politics…
I have met NPD specialists in various specialties including general medicine, psychiatry, GP and cardiology.
I have also come across wonderful, humane, highly personable surgeons.
I think it depends on the individuals involved. Doctors are human beings – they carry the same vulnerabilities like everyone else. Some developed NPD early on from the time they are younger and through out their lives.
Colleagues and patients often testify to this. Some are found out sooner and their cases come to the attention of the public via media or AHPRA.
We should have enough self awareness and not put up with the behaviours for too long.
Great article Leanne. Sensitively and carefully written. Noting that claims and counter claims of mental health issues including personality disorder labels can be inappropriate weapons in workplace dispute. These very difficult and challenging workplace behaviours need very careful unpicking by skilled panels of senior staff. Well said. It’s such a difficult area. Medicine is such a high performance workplace yet requires us all to maintain our sensitivity and ability to be cognitively nimble. We are all entitled to a safe workplace. Individual and organisational strategies for prevention remediation and change well worth the investment.
An excellent article.
There is very strong research evidence that the incidence of toxic workplaces, where bullying and narcissistic behaviour occurs is higher in all the caring professions. Many health practitioners recognise this. Unfortunately health administrators and our senior professionals have not wanted to accept it is, or are unable or unwilling to reduce the incidence or the toxic impact it has. It is unfortunately tolerated even in our methods of teaching students and in our training for postgraduate qualifications. It is almost expected and regarded as acceptable and tolerable behaviour that makes us resilient. The science consistently however has always said it is otherwise and points out the cost to our health system and to individuals. Even our registration and regulation authority (AHPRA) uses similar techniques and denies it is a problem when the system of notification of practitioners to AHPRA s misused. Often in the workplace there is a subtle and sometimes not so subtle threat that if you don’t toe the party line you risk being reported. We know just the act of being reported to AHPRA does enormous damage to careers and the health of the professional notified. The notifier however becomes a champion of the system and walks away with a “smirk” on their face. Our codes of professional conduct do not mention the misuse of reporting systems or “sledging” in the workplace as being non professional behaviour. To my knowledge AHPRA has never called anybody out for a “dishonest’ notification and Colleges and Associations have not removed the credentials of those guilty of such misconduct. Until we have real leadership from our senior professionals and administrators in this space the culture will not change. This has all been presented at two recent Senate Enquires but has been followed only with window dressing changes but no measurable action or change in health delivery workplaces.
John Stokes Chair Health Professionals Australia Reform Association
Opinion, Opinion, Opinion and not an evidence-based reference to be seen. In the pre EBM days, we struggled with opinion and it delayed solutions. Why is it that despite the failure of so many strategies we (you) do not consider RESEARCH (as in prospective trials).
Lots of surgeons lose their tempers. To say that all proceduralists are narcissists is as bigoted as saying all white people/black people/ (insert religion here) people have a given trait. Before launching into judgmental opinion why don’t you do some actual work and look at why?
Some weeks ago I was called in (when not on call) to extract an impacted head at a LSCS for obstructed Labour. I delivered an atonic unresponsive grey/white baby and passed it immediately away. I asked ‘Is the baby OK? (no answer) a few minutes pause and again “can you tell me about the child Please?” (still no reply). a further pause. (there was ‘difficult’ heavy bleeding from a descending tear in the lower segment When I finally asked: “is the baby alive?” The NNICU registrar still did not respond. As they prepared to leave the O/R I spoke to the NNICU registrar about communication in a multidisciplinary team. I started with “do you think we do this job for the sport of it”.
I have been reported as a bully. So: am I a narcissist? A bully? Or a victim? Have most of the readers of this have ANY idea how stressful it is to be salvaging one life from haemorrhage whilst not knowing if the point of the case was dead or alive?
Thanks for calling this out! There is no place for these types in medicine but we don’t seem very good at keeping them out or managing them if they do get in. Recent experiences of newly minted Ferrari driving orthopaedic surgeons doing unnecessary surgeries in private sector , charging massive out of pockets and causing scrub nurses to go off on stress leave after sustained verbal abuse.
It’s got to stop!
David Gillespie’s book “Taming Toxic People” is a good read and can help us spot them in our midst.
Great article Professor Rowe. I think it is so important to recognise those who have true empathy for patients and those who use patients as a means of being exulted. The line is very fine indeed – we all like to be liked – but the major difference is in the care factor. Money or self indulgence as the basis for patient care should never be accepted. True caring, the desire to do “good”, should always be the driving force for any human being in any situation.
This is a timely article. The problem in medicine is not new. What is different now is that sadly as the gender mix of medical professionals,especially those in more senior positions has changed, more of the perpetrators are proportionately women. Their behaviour is a little different but there is also a greater reluctance to confront their behaviour by their immediate superiors. There are a variety of reasons but the most obvious compelling reason is a sense that it appears sexist or chauvinistic to do so. After having experienced this aggressive serial bullying behaviour culminating in an an outrageous claim personally, as I work closer to retirement, the serial bully with whom I had to deal with continues to act within the protection of those above her as she creates havoc amongst those she is expected to lead, mentor and work with. We face a new generational problem if we all collectively continue to assume this problem has a fixed gender bias. It does not and if left unchecked could assume an unnatural gender bias of unnatural proportions in a perverse manner. Narcissists are extremely difficult to manage and almost are incapable of teamwork of any kid. It may we’ll be time to assess such types as they seek to enter medical envoirnments in whatever roles and exclude them before they are able t
Leanne,
Good article. I have never encountered so much bullying till I came to Oz from the UK. Perhaps it was also there but diluted by the numbers of doctors. Be that as it may, research to gather hard data is needed and I am sure a lot of what you said is true (but anecdotal). The lawyers have a great day twisting it further and creating something out of nothing! I agree with you that bullying is not uncommon and I will not hesitate to state that this was how Australia was first founded! I have my own challenges to deal with.
Thanks for a great article. Sadly narcissists seek power and often end up on boards, committees, and positions of influence for training position selection. We need to see more of the king pins behaving badly addressed to make a difference here. Only this level of response will build confidence in our complaint processes and responses and allow for those most at risk to put their heads above the parapets. Sadly surgery is a hot spot for narcissism, ICU is another one in my opinion.
NPD is also well represented in Medical Administration
Amazing article. Thank you so much
POTUS to a T
Does NPD have a greater prevalence in medicine compared to the general population? Within medicine, is the prevalence of NPD greater in surgery? Within surgery, is the prevalence of NPD greater in cardiothoracic surgery and neurosurgery?
It certainly has been my observation.
6%?
I think in some areas of practice it’s much higher