When Ego Enters the Exam Room: Managing Narcissistic Tendencies in Medicine

In the last blog post, we looked at the first over-represented personality type found in medicine, namely obsessive-compulsive traits.  In this second of three posts, we are examining another personality type commonly found in physicians, ‘Narcissism’.  Like before, I am steering away from the official psychiatric diagnosis of Narcissistic Personality Disorder, but will instead focus on some of the key features of the personality type.

Along with intelligent and driven people, med school attracts those with strong egos.  From day one, physicians are told that they are the best, brightest and most capable (or even earlier, if your parents are Indian or Asian).  The many years of training, frequent evaluations and exams, and high stakes decision-making reinforce a sense of authority.

So, it’s not a huge surprise that narcissistic traits, like desire for admiration, grandiosity, and intolerance of criticism are over-represented in medicine.  While these characteristics can help project confidence and leadership, when unchecked, they can lead to arrogance, strained relationships at work and home, and even bullying.

For practicing physicians, awareness is key.  Here are some common ways that these tendencies show up, why it’s bad, and how to manage them in a constructive way.

1. Overvaluing Status and External Validation

   After years of grinding for marks, residencies, and awards, many young MDs continue chasing external approval from colleagues, mentors, and patients.

   
   

   Why it happens

   1. Medicine selects for high achievers who equate self-worth with test performance.

   2. The culture of prestige (fancy titles, fellowships, awards) re-enforces the seeking of status.

   3. Constant scrutiny during training wires physicians to crave positive feedback.

   Risks

   1. Prioritizing image over substance makes the goal appearing competent instead of being open to learning

   2. Constantly chasing validation is a good recipe for burnout.

   3. Disappointment if recognition doesn’t come, which can fuel resentment.

      
      

   Strategies

   1. Focus on more intrinsic rewards, like the satisfaction of patient care, problem solving, and mentorship.

   2. Practice what called “quiet excellence”, where you let results speak for themselves.

   3. Reflect regularly on the purpose of medicine, which is to heal, not impress.

      
      

2. Dismissing or Bullying Others to Protect Your Ego

   Some physicians use intimidation or condescension when they feel challenged.  While it may seem like malice, it could be insecurity in disguise.

   
   

   Why it happens

   1. Medical hierarchy rewards authority and ‘toughness’.

   2. Fear of appearing weak or uncertain leads to defensive aggression.

   3. Stress amplifies these ego-driven reactions.

      
      

   Risks

   1. Damaged team morale and high staff turnover.

   2. Loss of trust and collaboration.

   3. Poor patient outcomes from silenced or disengaged staff.

      
      

   Strategies

   1. Develop self-awareness where you notice when irritation stems from feeling threatened.

   2. Replace control with curiosity.  Ask yourself, “What am I missing here?”

   3. Invite an atmosphere where colleagues and allied health professionals can disagree with you.

   4. After tense interactions, debrief and repair.  Admitting mistakes strengthens respect.

      
      

3. Overestimating Your Abilities (‘Grandiosity’)

   Confidence is necessary in medicine, but when not controlled, it can become dangerous.  Physicians who assume that they’re always right can ignore feedback, dismiss guidelines, or skip double-checks.

   
   

   Why it happens

   1. Years of academic success reinforces self-assuredness.

   2. The culture of ‘never show weakness’ discourages humility.

   3. Patients, trainees and junior peers may feed the perception of infallibility.

      
      

   Risks

   1. Increased likelihood of error.

   2. Resistance to innovation or new practices.

   3. Alienation of colleagues and harm to reputation.

      
      

   Strategies

   1. Actively ask for feedback, even if you think it might be uncomfortable.

   2. Practice humility; no one is always right.

   3. Use peer review and case discussions as learning tools, not personal judgements. 

      
      

4. Needing control over everything

   High-ego MDs often feel anxious when things don’t go exactly their way, whether it’s scheduling, patient management, or running a clinic.

   
   

   Why it happens

   1. Deep need for predictability and order in an often chaotic environment.

   2. Fear that others won’t meet your high standards.

   3. Identity tied to being ‘the one in charge’

   
   

   Risks

   1. Conflict with peers, allied health professionals, and administrators.

   2. Micromanagement that stifles team initiative.

   3. Personal frustration and exhaustion.

   
   

   Strategies

   1. Delegate, assign responsibility, and fight the urge to do everything yourself.

   2. Practice ‘detached involvement’, where you still care, but don’t control everything.

   3. Remember that leadership is about influence, not dominance.

      
      

5. Struggling with criticism

   Physicians with strong egos often take feedback personally, interpreting it as an attack as opposed to an opportunity to improve.

   
   

   Why it happens

   1. Medical training associates mistakes with shame.

   2. Personal identity is tightly bound to professional competence.

   3. Narcissistic tendencies magnify sensitivity to perceived disrespect.

   
   

   Risks

   1. Emotional reactivity or defensiveness.

   2. Stagnant growth from lack of self-reflection.

   3. Strained relationship with mentors.

      
      

   Strategies

   1. Pause before reacting.  Ask, “What part of this feedback may be true?”

   2. Ask for specific, actionable feedback, not general praise.

   3. Normalize error.  Everyone misses things; growth comes from owning them.

   4. Model psychological safety for others.  Show that accepting feedback is normal and encouraged.

Medicine rewards confidence, but too much confidence can quickly slide to arrogance.  Narcissistic traits balanced with humility and empathy can make for decisive, inspiring leaders.  However, when not mitigated, narcissistic tendencies corrode teams, harm patients and take away joy in the practice of medicine.  For newly practicing MDs, the challenge is not to suppress your ego, but to train it.

• Use confidence to reassure patients and co-workers, not dominate them.

• Use ambition to drive improvement, not comparison.

• Use leadership to lift others, not control them

  
  

The best physicians aren’t those that demand admiration.  They’re the ones who earn respect quietly through competence and kindness.

Author: Dr. Krishna Sharma, Director of Physician Engagement, Specialty Medical Partners

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