By Karen Foster MSc
When I was first asked to write a blog about my experience of accessing health services I thought at first, that I’d simply be writing a description of my interactions. However, after thinking about this in greater detail it dawned on me that the negative aspects of what I and the many people I have subsequently spoken to have encountered, is only a very small part of what seems to be a much larger concern. There appears to be a disease epidemic sweeping through many of the NHS GP surgeries, and this disease I believe should be labelled narcissism. I’ve recently read a very interesting book by John Banja titled ‘Medical Errors and Medical Narcissism’. Here Banja states that the characteristics of the medical narcissist include emotional disengagement, ideological rigidity and compulsiveness. He goes on to say that although these traits would originally start in childhood, they are later reinforced during medical training. This may explain why it seems so prevalent and why it has earned my label of ‘epidemic’.
Interestingly, although this disease seems to affect large numbers of physicians, it does not appear that they stand together as a group. In the 1970’s, a psychologist called Henri Tajfel introduced the idea of social identity theory which has helped to inform a lot of research around discrimination exploring how and why groups form. What appears to be happening with our physicians is incongruent with Henri Tajfel’s ingroup/outgroup theory where the two groups are totally dichotomised and the ingroup members support each other unquestionably, as is the prerequisite of this membership. This is a much more complex issue. Although the physicians are all members of the same group, they take an independent stance within this group and quite often against each other. In my own experience as a medical and health professional, I have witnessed the cohesive, public defence of a colleague who has been accused of negligence but, in private, I’ve witnessed his annihilation. Publicly they close ranks, and this has been witnessed in many of the recent governmental inquiries such as the Bristol Inquiry.
I believe that most people have probably experienced this form of narcissism in some shape or form and it can be evidenced in a number of ways. Has anybody ever had the misfortune of a physician choosing not to acknowledge a condition that had previously been diagnosed by someone other than themselves or originating from their clinic? I certainly have. This has ranged from very minor complaints to rather serious genetic conditions and has left me rather baffled as to why this would be denied. Having spoken to other medical professionals, it has been suggested that this may be attributed to avoidance of cost for their surgery, but surely it has to be more expensive to start the diagnostic process from the beginning rather than continuing pre-existing treatment. I really do believe that this is nothing short of their own arrogance, with the presumption that only they should make that diagnosis. The Oxford Medical Dictionary defines narcissism as “an excessive involvement with oneself and one’s self-importance”. I think this is a very apt description of what appears to be happening here.
I’ve worked in the field of health and medicine all my adult life and am educated to postgraduate level in a non-clinical field. Although I am not a physician, my medical and biological knowledge is quite good. In addition, fuelled by my position as a scientist and coupled with being someone who values quality and attention to detail, I spend a lot of time on additional research for any medical concern I may have. Therefore I find it infuriating when met with comments such as “and what is it you believe you understand about this condition”? or “I’ll be the judge of that” when discussing my concerns. This attitude has often resulted in a very protracted (and an unnecessarily costly) route to a diagnosis for which I had originally suggested. Being knowledgeable about biology coupled with the knowledge of one’s own body’s functioning should be advantageous to a consultation, when this is accepted as collaborative. Unfortunately, this does not seem to be the case when dealing with a narcissistic personality, and is regularly met with patronising and condescending comments. A narcissist will resist input from anyone else, and these type of responses are all symptoms of the narcissistic personality. Banja suggests that those afflicted with medical narcissism have an intense anxiety about their own welfare, therefore would not take kindly to a patient either questioning or suggesting. However, there have been occasions where I have not divulged my professional background nor presented any further information beyond an explanation of symptoms, taking a submissive and an almost obtuse position. This has elicited a very different response, one which is pleasant and polite but authoritarian. However, before I develop an inferiority complex regarding my lack of clinical qualifications and thus the derogated status in which physicians perceive me to be, this attitude has also been regularly experienced by friends and colleagues who are clinically qualified. So it seems that this is the default position shown to all ‘patients’ who do not ‘play dumb’.
However, it is necessary to consider how much of the blame for this disease afflicting our physicians we should we take responsibility for ourselves, as patients. Have we as a society sat subservient for too long, therefore creating and thus enabling this behaviour? We have for many, many years been conditioned to believe that physicians’ authority is not be questioned but maybe it is now time to make some adjustments to this relationship. We need to rebalance the power, thus helping our health and wellbeing in the process by allowing the patient to play a respected and proactive role. An informed patient can be an asset to any consultation process, with studies showing that a when a patient feels they are involved in a collaborative process there is greater adherence to treatment regimens. The narcissistic physician supports physician- centred medicine, however for effective health outcomes it is necessary to change this to patient-centred medicine where the patient is given a voice and the ability to take responsibility for their own well being.
By Karen Foster