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All articles found in the archive are more than three years old.


The purpose of this blog is to stimulate thought and discussion about important issues in healthcare. Opinions expressed are those of the author and do not necessarily express the views of CMDA. We encourage you to join the conversation on our website and share your experience, insight and expertise. CMDA has a rigorous and representative process in formulating official positions, which are largely limited to bioethical areas.

Narcissism in Healthcare

May 17, 2017

by Autumn Dawn Galbreath, MD, MBA

I was looking up some information on the American Association for Physician Leadership website when an article caught my eye: “Are You a Narcissist?” I hadn’t decided what I was going to blog about this month; not surprisingly, narcissism was not on the list of things I was considering. But the article piqued my interest, so I clicked on the link and read the entire thing. There was even a quiz I could use to find out if I am a narcissist. You will be relieved to know I “passed” the quiz with a non-narcissist score! That was reassuring, but I was curious as to why this article interested me so much.

I have long been accused (maybe since birth!) of having a “strong personality,” which is a euphemism for being a bit pushy and determined. My parents first noted this particular quality in me. Their approach was that my “strong personality” had to bend to theirs. Some of my friends over the years noticed it, and their approach was often to distance themselves from me. My husband and children notice it and have the best approach of all. They point it out to me and remind me that other people’s opinions matter, too-that I don’t have a monopoly on good ideas.

I’m going to go out on a limb and guess that more than one of you has also been accused of having a “strong personality,” or worse. A classic 1985 JAMA article described the three dominant traits of physician personalities as doubt, guilt feelings and an exaggerated sense of responsibility. Given that most of us share these personality traits, how can we help having “strong personalities?” In fact, is it not those very personalities that make us good physicians? Isn’t it our exaggerated sense of responsibility that makes us willing to get up in the middle of the night on a regular basis to answer phone calls or physically evaluate a person who is sick? What about the time you spent researching all the zebras that could have been the underlying cause of that case you just couldn’t make sense of last week? Wasn’t that some combination of doubt and your sense of responsibility? And don’t even get me started on the years we spent working more than double the hours of a normal work week, while also spending those precious few hours away from the hospital reading about the patients we left behind at the end of the day.

On the other hand, the JAMA article goes on to describe the maladaptive manifestations of these personality traits: “difficulty in relaxing, reluctance to take vacations from work, problems in allocating time to family, an inappropriate and excessive sense of responsibility for things beyond one’s control, chronic feelings of ‘not doing enough,’ difficulty setting limits, hypertrophied guilt feelings that interfere with the healthy pursuit of pleasure, and the confusion of selfishness with healthy self-interest.”

Do you cringe when you see a certain person’s number on your phone screen, knowing you will “have to” lend him money again? Do your kids ever ask why you never come to their soccer games? Do your hobbies all end with some kind of product or involve intensive training, such that they are really just work by another name? Have you built up hours and hours of vacation time because you just couldn’t get away? I actually once had a boss who was frustrated a physician in our group was going on vacation and said, “Just because we give you six weeks of vacation a year doesn’t mean you have to take it!”

“Yes,” you say, “but working hard doesn’t make me a narcissist!” Of course it doesn’t. But do you resent how hard you work? Do you even sometimes take it out on other people? Do you expect them to live by to the same perfectionistic standards you do? Do feelings of superiority cause you to reject other people’s ideas? What is your response when the operating room staff doesn’t have the instruments you want, or how about when your office staff messes up the billing?

I’m not trying to convince any of us that we are narcissists. I simply want to challenge each of us to think about our doctor personalities. In what areas are our strong, determined, goal-oriented, self-doubting, overly responsible selves serving us well and contributing to a good life? And in what areas are they making us good healthcare professionals at the expense of being good friends, good spouses or good parents? If we hold a mirror to ourselves and really look, where will we see ourselves putting undue pressure on those around us, holding them to too high a standard? For that matter, where will we see ourselves holding ourselves to too high a standard? A wise man once told me, “It’s a mighty thin dime that doesn’t have two sides,” by which he meant those who are unwilling to have compassion for their own weakness and vulnerability will be unlikely to have compassion for those of other people as well.

Taking these questions to a deeper level, where are our doctor personalities, gifts and talents allowing us to depend on ourselves, rather than on God? A mentor and medical school faculty member of mine, Dr. Fred Richards, deeply impressed these words upon me in a graduation speech: “God has given you a lot of cortex, so you’re not going to HAVE to need Him. But if you WANT to need Him and if you BEG to need Him, and if you depend on Him every day, then you can get credit for your profession in heaven. If you don’t depend on God, then it’s just a profession.” The differentiation between healthcare as a ministry, carried out by people who depend on God daily and use their gifts and “strong personalities” to further His work in the world, versus healthcare as a profession, carried out by people whose gifts and personalities can carry them a long way in the world, is a critical one for us to ponder as Christian healthcare professionals.

Autumn Dawn Galbreath, MD, MBA

Autumn Dawn Galbreath, MD, MBA

Autumn Dawn Eudaly Galbreath, MD, MBA is an internist in San Antonio, Texas, where she lives with her husband, David, and their three children. Though they met in medical school, David now owns a restaurant in the San Antonio area. Between the two of them, they have experienced multiple career transitions and weathered the resultant stresses on their marriage and family. Autumn Dawn speaks to the issues of Christian marriage, being a working mother in the church, and being a woman in medicine with an engaging humor that brings perspective to these difficult issues.

Autumn Dawn earned her MD from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.