My colleague is a narcissist

On morning rounds one day, I met a 26-year-old male who had been in and out of the hospital for years with Crohn's disease. This time, he was on the verge of an infection so severe, we would have to operate to avoid necrosis. 

My job was to explain to him why this operation was necessary; however, he didn’t want to hear it. He refused to go into the operating room, because he said he didn’t want a bowel dissection, and he did not want to wear a colostomy bag.

My colleague started exhibiting narcissistic traits

On rounds, I explained to my team that the patient was not ready to face surgery because he was terrified of the outcomes.

She said no patient in their right mind would rather die of a dead bowel than go under the knife. I told her that I disagreed, and that quality of life is very important, so I fully understood his reservations. The upper-level resident told me I was not a good doctor because I was not able to convince the patient to agree to surgery, then she told me I was off the case. I was dumbfounded and hurt, especially because this was my continuity patient from the clinic. 

She made me feel incapable

I was excused from rounds the rest of the day and told to go write discharges for patients on the floor. I was made to do “scut work” because I valued my patient’s decisions and values over my chief resident’s opinions. When the patient found out that I was no longer on his case, he stated that if a team was going to round on him, I must be present. 

I later discovered that my chief resident had talked down to him, rolled her eyes, shook her head, and hurried out of the room mid-conversation.

I did not approach my colleague or the residency program director regarding this behavior, but in hindsight, I should have talked to a supervisor so the situation could have been documented and the faculty could have taken action. However, I talked through my feelings and emotions with my support system, and it helped to not let the emotional toll from this experience fester. 

The many personalities in medicine

Narcissism is a personality trait that is characterized by self-importance, lack of empathy, and the need for attention. These individuals often have low self-esteem and offset their insecurities by manipulating, controlling, and gaslighting others. 

John Banja, PhD, wrote a book on medical narcissism, a term coined to describe a defense mechanism employed by doctors who try to convince themselves they are virtually indestructible, able to handle any situation. 

We as physicians constantly work under immense pressure. Some believe physicians develop this trait to cope with the psychological stress associated with the job. Dr. Banja believes this is not pathological narcissism, but rather a coping mechanism of narcissistic personality traits among physicians.

Common phrases you might hear from a narcissist

A narcissistic personality may be well-hidden behind charm. Here are some phrases you might hear from a narcissistic colleague, and the meaning behind them.

• “I don’t want to make this about me, but…” People with narcissistic traits are aware they shouldn’t try to be the center of attention, but they grab for it anyway.

• “I’m sorry you feel that way.” They may have a difficult time admitting fault, and this type of apology pins the blame on the other person while they deflect their feelings. The narcissistic person is implying that your feelings are your own issues, and they won’t be taking any blame for how they make you feel. 

• “I’m a busy person, I don’t have time for this.” These individuals often lack empathy and believe that their priorities and time are more important than anyone else’s.

• “Why are you doing this to me?” Shifting blame and playing the victim is a clear-cut narcissistic trait. You may be the one who is struggling with burnout at work, but your struggles will be framed to inconvenience the narcissistic person.

• “It's not fair!” Individuals with narcissistic traits often believe that rules do not apply to them, and if they are forced to comply, or if a consequence is enforced because they broke the rules, the situation will be deemed unfair. 

• “I hope you know who you’re dealing with.” This tactic of finding power by making threats creates an illusion of control. It often forces the other person to comply, because they do not want to deal with a perceived threat. 

Addressing narcissistic behaviors

I believe that confronting the issue head on is imperative in order to repair the workplace relationship, especially as patients can be involved.

If you are uncomfortable addressing this situation with a coworker (rightfully so), or if there was no healthy resolution, you can document everything and bring it up with your superiors. Without asking for help, the individual may continue to act in narcissistic ways, which can compromise a healthy workplace as well as your mental and emotional health. It can also potentially compromise patient care. 

As always, remember to take care of yourself. Talk through your emotions with your support system or a therapist and try to understand that you are not at fault; you are not a bad doctor and you do not deserve to be treated this way.