The Irish Medical Council has invited occupational psychologist Dr Jenny King to speak about doctors' high-handed behaviour. Sylvia Thompson reports
The narcissistic personality that is well recognised in industry is becoming increasingly recognised among senior doctors, according to an expert in the psychology of the workplace.
"These doctors believe that all patient care revolves around them and their expertise," says occupational psychologist Dr Jenny King.
Dr John Hillery, president of the Irish Medical Council, spoke recently of the need to "teach doctors cultural competence".
He also said that doctors often operated "in a separate culture from patients which leads to barriers including miscommunication and a lack of empathy".
There is growing unease in this country that an arrogant manner has become the modus operandi of some doctors. This style of behaviour is often reinforced by the hierarchical nature of the medical system.
According to King, research in the airline industry found that when the captain (pilot) is arrogant, boastful and hostile, more errors are made. There is also widespread belief that it is rude doctors, not bad doctors, who are more likely to get sued by patients.
Analysing the behaviour that is leading to troubled medical teams and looking at the personality traits of difficult doctors are the central core of King's work. Which is precisely why the Irish Medical Council has invited her to speak at its conference, Performance and Remediation in Practise . . . supporting doctors, protecting patients in Croke Park, Dublin on Friday.
"We look at how personality contributes to poor performance such as poor team work, disruptive or high-handed behaviour in operating theatres, chaotic time-keeping, poor leadership and lack of consideration of colleagues," she says.
From their assessment of 150 doctors in difficulty, King and her colleagues at the Edgecumbe consultancy firm in Bristol, the UK, have found that such doctors display extreme levels of perfectionism when under stress.
"Their normal diligence gets overplayed and becomes obsessional. They become increasingly demanding, rigidly uncompromising and hypercritical of small mistakes. They are also very hard on themselves which leaves them at risk of burnout," she says.
King is co-editor of Understanding Doctors' Performance (Radcliffe Press, 2005) which looks at why doctors underperform, covering areas such as education and training, physical and mental health, workload, personality, organisational culture, drug and alcohol misuse. The book also examines how problems can be prevented.
King is keen to point out that most of these doctors are highly motivated, very committed and caring but they get into difficulty when they take such qualities to an extreme. She says that if they have some insight into their behaviour and they are motivated to change, these doctors can be helped.
"One strategy is for such doctors to seek feedback from someone they trust. This person can then tell them when their behaviour is crossing the line. Another strategy is to give them coaching on learning how to prioritise things and building up a resilience for handling feelings of stress."
However, she adds that there will always be the "high cost, high benefit" individuals who simply need to be ringfenced. "The recommendation for these people is to limit the damage they can cause to those around them by only having people who can deal with them, working with them."
King mentions one surgeon who was displaying disruptive behaviour to his colleagues, becoming militant and antagonistic to everyone around him. "He was very upset about the standards of infection control in the hospital he worked in. He came close to damaging his career because he couldn't regulate his own behaviour and actions.
"But, when he learned to identify the causes of his stress and the strategies to manage it, he was nominated to become the next clinical director of the hospital."
Not all cases have such happy endings however, and the Irish Medical Council is becoming increasingly aware of the need to tackle core problems both within the training of doctors and the hierarchical system which militates against junior doctors questioning the behaviour of their senior colleagues.
The collegiate nature of medical consultancy is also said to have led to medical peers failing to criticise colleagues as in the case of consultant obstetrician Dr Michael Neary in Our Lady of Lourdes hospital in Drogheda.
"We are doing more and more work with doctors at registrar level [just below consultant status], teaching them skills of leading a team, teaching them how to become more self-aware and how to regulate their emotions under pressure," says King.
See www.edgecumbe.com