Are all surgeons arrogant? (the psychopathology of power)

In this blog post, we will answer the following question: Are all surgeons arrogant? We describe the consequences of arrogance in medicine and discuss what it means to be a good doctor. 

Are all surgeons arrogant?

We do not believe that all surgeons are arrogant. Although, we have all seen or heard of surgeons that feel that they do not have to give any explanation for their behavior, nor be accountable to their colleagues, too much higher courts: they only have to respond to history (of the hospital, service …) or to God. Of course, they will always be acquitted.

Surgeons that show no compassion for patients or colleagues. They cannot put themselves in the place of the other because they do not consider themselves their equals. They are immune to others’ misfortune: they can joke, laugh, and tell jokes after an adverse surgical event, however unfortunate it may be. 

They know the profession or position that their patients hold (especially the most distinguished ones). Still, they don’t know anything about their personal life since a fundamental way of empathizing is to sit down and talk with them. 

In this article, we wanted to explore the idea of power, especially the doctors’ power, and understand what hides behind it.

The concept of power in human relationships is analogous to energy in the world of physics. According to Bertrand Russell, it is the essential element, the ultimate goal of the human being, and, along with glory, one of a person’s main infinite desires. As early as 1987 McClelland identified power as one of the three basic needs of the human being. 

In 2008, the neurologist, member of the House of Lords, and former British Chancellor David Owen published a book in which, attracted by the behavior and psychological profile of certain politicians (parliamentarians, dictators …), he coined the term ‘ hubris’ syndrome (SH) to describe leaders who believe they are called to do great works. 

They show a tendency to grandiosity and omnipotence and are incapable of listening, showing themselves impervious to criticism. Owen analyzes the behavior of politicians like Roosevelt, Ariel Sharon, the Shah of Iran, Bush, Blair, etc., and dedicates a chapter to the democratic protection measures against the rulers with SH. 

For Owen, the SH is inextricably linked to power and fueled by success. He describes it as an acquired and reversible disorder (it can remit when the power disappears).

In 2009, David Owen himself and the psychiatrist Jonathan Davidson proposed that SH be viewed as a new psychiatric disorder, a cluster of symptoms that make up an easily recognizable syndrome. They collect the 14 symptoms that characterize it, of which five are specific (unique) of SH. 

9 characteristics of arrogant surgeons

We propose ten diagnostic criteria that make up the clinical picture of the doctor with SH, very characteristic, and easily recognizable in daily clinical practice.

1. The world in general (and the hospital, service, and operating room in particular) is an arena where you can exercise power, demonstrate your capabilities, and seek glory.

Great deeds are expected from them. They are called to do great work (“I always wanted to be a neurosurgeon before I was a doctor“). The very essence of medicine is the vocation to help, to serve, to relieve. For the doctor with SH, this vocation to help is secondary to the seduction of power. They have always wanted to be neurosurgeons to exercise power and show the world what they are capable of (achieve glory).

2. Exaggerated self-confidence, feeling of omnipotence: ‘hubristic’ incompetence

They overestimate their own capabilities: Exaggerated self-confidence can lead to ‘hubristic’ incompetence. Successes make them reckless: they successfully intervene on a patient with lumbar stenosis, re-operate him for dorsal stenosis, and re-operate him for cervical stenosis until a fatal outcome occurs. Success can lead to disaster; 

Omnipotence: they can and they know everything (of any technique/tumor type, however rare, they have operated on a case before). Self-confidence and the feeling of omnipotence make them feel special and demand favorable treatment. They often adopt arrogant, distant, and overbearing attitudes towards patients, nurses, and other colleagues that they do not consider their height.

3. They despise the advice and criteria of others: they should only answer before the highest courts (God, history)

They do not listen: they are not capable of dialogue, of exchanging arguments: the only valid ones are theirs. They tend to raise their voices and, once their arguments have been made, end the discussion because the only valid point of view is their own and they are not interested in that of others. 

They surround themselves (administrative SH) with doctors who do not dare to contradict them, forming the ‘toxic tandem’. No one will dare to defend a different position (surgical indication, approach, patient management …). In the clinical sessions, there is a ‘consensus’ of the entire service since there is no opinion that disagrees. 

4. Identification with the institution (service) to which they belong

They are a single entity and have identical interests. They are not ‘part of …’, but rather they ‘are’ the service. This is especially accused of physicians with administrative responsibilities (administrative SH), to the point that they come to believe they are owners of the institution (“I accepted the position because it is my hospital, my service”).

 They ensure that everyone knows the hierarchy and their position in it. They can’t stand being ignored, they need to be in absolute control.

5. Restlessness, recklessness, impulsiveness

They suffer from a lack of impulse control and often suffer outbursts of irrational anger. When they are ignored or their self-esteem is threatened (‘narcissistic wound’), they may suffer a fit of anger, they tend to raise their voices and in those moments they are impervious to any reasoning.

6. Excessive concern for their image

They tend to self-glorify, to perform acts to improve their reputation. They care about their appearance, presentation, the image of themselves that they show to others: the tendency to bombast (affectation), eccentricity (they think they are special and unique), clothing, luxuries, the exaltation of their travels …

7. Language changes

Of the 14 symptoms proposed by Owen, at least four involve linguistic issues. Owen emphasizes the use of the third person and the royal form of us (‘royal we’). But other criteria, such as the messianic way of talking about everyday issues, the tendency to exaltation, exaggerated self-confidence, the feeling of omnipotence, impulsiveness … have a direct impact on the way of speaking and expressing oneself.

Garrard [15,16] analyzed the speeches of different leaders with SH (Blair, Thatcher …) to highlight the changes in language. He found an increase in the use of some words, such as ‘true’, ‘sure’, ‘success’ …

The language of the doctor with SH reflects their feeling of grandstanding and superiority (they use far-fetched words, Latin adages), impulsiveness (they tend to gesticulate and raise their voices), omnipotence, and self-assurance (use of adverbs such as certainly, surely, evidently … ).

8. Loss of contact with reality and progressive isolation

The HS doctor considers himself special, unique, with an exacerbated feeling of omnipotence and self-confidence. Does not respect the personal space of others and often shows arrogant behavior, despising the opinions of others. 

All of this makes daily treatment very difficult (doctors from other specialties, nurses, auxiliary personnel …), leading to progressive isolation and loss of contact with reality (they are not able to see it).

9. Conviction of his moral rectitude

They are convinced of their good work, regardless of the costs. They show off their open-mindedness, ignoring details and fine print, and justify their actions by the end they pursue (which will always be morally correct). 

The doctor with administrative HS claims to act not for his own good, but for that of the service (in reality they are a single entity). She makes decisions about the professional life of certain physicians based on the good of the institution, ignoring the “details” (their repercussions on their lives), always convinced of her moral rectitude.

What does it mean to be a good doctor?

Many doctors forget that patients are as smart and good observers as they are. The patient immediately feels … if you are in control of the situation if you have experience if you are in a good or bad mood. If you pay attention to your patient, you will see that it modulates depending on your condition. 

He gets scared with you, he laughs when you laugh and you are motivated. The danger comes immediately: if you miss an inappropriate expression it will run away in anxiety, if not in fear. For a doctor, onomatopoeias are not good. Neither the loud tone nor the unchecked cry for a younger colleague or nurse.

Just as doctors look at patients carefully, so do patients look at them. I argue that the doctor should not sit on an armchair and the patient somewhere, small, on a stool, to contemplate the “personality”.

Medical psychology is a necessary subject that would be repeated over the years of study, even after years of practice.

Final thoughts for doctors and patients

Being empathetic, being a doctor, means, first of all, communicating with your patient, asking him questions and listening to him, then putting yourself in his shoes so that you can truly understand what he is going through and give him the support he can afford. 

Maybe for one, it is more important to buy a gift for the grandson than medicines, maybe a woman will choose to go home to take care of the children alone than to stay hospitalized for a few days in the hospital, maybe another prefers to go on a vacation in around the world than to do chemotherapy, the examples are many. The theory could say exactly what each patient needs, but empathy decides what the patient will do. Without it, you can half call yourself a doctor.

Keep your patience and humility. These are the two most essential qualities in a doctor’s career. We often hear people say that x doctors are arrogant and have moments of superiority, but in medicine, arrogance and pride are dangerous. Openness to the new and to the patient will help you evolve. 

Medicine does not start today and ends in 10 years. Medicine brings you something new every day, accepting evolution in the order it comes, organically, gradually, and with a lot of patience.

If you have any thoughts, comments, or questions to share, please let us know!

Bibliography

 1. Russell B. Power: a new social analysis. London: Allen G. & Unwin; 1938.

 2. McClelland DC. Human motivation. New York: Cambridge University Press; 1987.

 3. Owen D. In sickness and in power: illness in heads of government during the last 100 years. London: Methuen; 2008.

 4. Owen D. Hubris syndrome. Clin Med (Lond) 2008; 8: 428-32.

5.  Wray T. The role of leader Hubris in the decline of RBS and Lehman Brothers. In Garrard P, Robinson G, eds. The intoxication of power. London: Palgrave Macmillan; 2016. p. 229-51.

6. Young P. Hubris syndrome. Frontiers in Medicine 2016; 11: 99-100.