Tuesday, January 17, 2006

Marcus Welby Narcissus, M.D.

I have a good friend with whom I share many books; he is always lending me one book or another that he thinks I might enjoy, and I try to reciprocate. Recently, I lent him my copy of Under the Banner of Heaven --- a fascinating, disturbing, and very well-written look at the violent world of American polygamists by Jon Krakauer. When he gave it back to me, he had two copies of a page in the book, one for me and one for him to keep --- it lists the personality traits of narcissistic personality disorder:

  1. An exaggerated sense of self-importance
  2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Believes that he or she is "special" and can only be understood by, or should associate with, other special or high-status people
  4. Requires excessive admiration
  5. Has a sense of entitlement
  6. Selfishly takes advantage of others to achieve his or her own ends
  7. Lacks empathy
  8. Is often envious of others or believes that others are envious of him or her
  9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes
The DSM IV states that this diagnosis can be made in a person who exhibits 5 or more of these traits; the lifetime prevalence rate of NPD is approximately 0.5-1 percent; almost 75 percent of individuals diagnosed with NPD are male.

So, as he handed this list to me, he winked and loudly asked (in the surgeons' lounge), "Look familiar? Recognize anyone?" And he's right. To one degree or another, most surgeons could be accused of harboring a few of these personality traits, particularly while in the OR; many might say that the phrase "narcissistic surgeon" is redundant. In many instances, that's a good thing --- you don't want a surgeon who is indecisive or unsure of him/herself. In others, that's a bad thing --- empathy is an important quality, for example, as long as it does not keep the surgeon from doing the right thing.

But what about the truly narcissistic surgeon? The kind of guy who thinks that the electric company generates power just so that he can operate? Everyone has read fictional (and occasionally non-fictional) accounts of this type of surgeon --- with cardiac surgeons being the prototypical narcissistic physicians. Do they really exist today, or are they an anachronism as out of place today as the ether mask?

The short answer is "yes," in my experience. However, I have a sense that there are far fewer narcissistic surgeons around today than, say, 30 years ago; that's a good thing, as they can make life miserable for the people with whom they work (and even more miserable for the folks that have to discipline problem physicians in hospitals and medical boards). Perhaps mine is a regional perspective -- in the west, we tend to attract a certain type of physician personality, and it could be that things may be somewhat different in New York City (I'm not trying to pick on anyone) or in L.A.

SWIMBO would probably say that all of us are narcissistic, with me at the top of the heap, but I wonder if those non-surgeons out there would say the same. Are we surgeons still viewed this way, or have times changed?