Medicine: Breeding Grounds for Narcissism

Medicine: Breeding Grounds for Narcissism

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http://www.thehealthculture.com/tag/doctorpatient-relationship/

As I reviewed his publications, I came across a synopsis of Dr. John Banja’s book, Medical Errors and Medical Narcissism, and an interview in which Banja discusses the gist of his aforementioned book. In his interview, Dr. Banja describes a medically narcissistic physician as either an “arrogant, imperious, prima donna physician around whom the world turns,” or “a very bright, compulsive, hard-working individual who lives in a very stressful world.” He focuses on the latter, as it describes the more common medically narcissistic physician.

I found Dr. Banja’s interview interesting because, among many other things, he explains that medical narcissism is largely something that is bred, not born. In other words, as medical students and doctors progress throughout their lives in medicine, they inevitably develop narcissistic qualities in what Robert Millman calls “acquired situational narcissism.” It is not the case that narcissistic individual enter medicine. Banja says that physicians find themselves in extremely stressful conditions, in which innumerable medical errors buffet physicians’ self-esteem, that push them to become narcissistic as a defense mechanism for their “professional self-confidence.” Additionally, physicians find themselves in a state of gratuitous adulation. Such factors, according to Banja, result in the medical narcissist.

Banja proceeds to make the point that it is because of medical narcissism that physician relational skills ebb away. As a result of daily buffets to their “professional self-esteem,” which comes in the form of difficult, obnoxious, anxiety-generating,  sickly patients, physicians develop a defense mechanism (medical narcissism) which desensitizes them to the emotional needs of their patients. Such a phenomenon is responsible for the drop in empathy and interpersonal skills so prevalent among doctors.

My question is, how fixable is the problem of medical narcissism insofar as its effect on physician empathy and interpersonal skills? The problem of the shady physician, running from one patient to the next, never really emotionally investing in anyone, is evinced throughout healthcare in this society. Consequently, there have been many initiatives on the medical school admissions level, undergraduate medical education level, and graduate medical education level to circumvent this growing plague. Many medical schools (especially those which use Multiple Mini Interviews for their admissions process) strive to a admit  personable, socially adept candidates. Many medical schools have implemented in their curricula material that seeks to cultivate interpersonal skills. And many graduate medical programs and medical practices hold workshops to reverse the unapproachable, cold-hearted personalities of many of their physicians. But how effective are these initiatives if the problem is not that impersonal doctors were let in in the first place but that impersonal doctors resulted from the practice of western medicine? If medical narcissism, and all of the negative consequences that come with it, is really a bred problem and not a born problem, what can we as a society do to ameliorate the many crises that doctor-patient relationships find themselves in?

Bibliography:

http://webmm.ahrq.gov/perspective.aspx?perspectiveID=19

http://www.nejm.org/doi/full/10.1056/NEJM200507213530324