In a recent housecleaning of my files, three sources on the same subject piqued my interest even more than the first time. A clip from the New York Times Book Review (7 February 2010) was written by Lee Siegel and is entitled, “The Book of Self-Love: Narcissism;” in it he reviewed a book by Christopher Lasch written some three decades ago called The Culture of Narcissism; and a column on the same subject in the Times by Frank Bruni, “Individualism in Overdrive” (16 July 2012).
These articles resonated with me because of a growing feeling of uneasiness I have had about the attitude and direction of many medical caregivers.
Narcissus is a character in Greek mythology. He was a very handsome young man loved by many, but Narcissus really loved no one but himself. The gods cursed and punished him for his selfishness by having him fall in love with his own image in a pool of water that, of course, could not return his affection.
So narcissism is the inordinate fascination with oneself and excessive self-love. It can also be vanity, self-centeredness, smugness, or egocentrism. Put in contemporary terms, narcissism would be defined as “it's all about me.”
What does this have to do with medicine and physicians? Where do I start? When we talk about big egos in medicine, we non-surgeons often are referring to some big-time surgeon with a “Messiah Complex,” who boasts, “I can save anyone with my surgical skills, which should be admired and even revered by others.” But, unfortunately, narcissistic behavior can be found in physicians in every specialty and sub-specialty, as well as in hospital administrators, pharmaceutical and insurance companies, academic health centers, and private practices.
In fact, nurses may be the last bastions of medical professionals focused primarily on the common good.
Although I know many physicians who often make sacrifices of their time, energy, or income for their patients, there have always been individual narcissists in medicine. What I am talking about here, though, it is the scope of the latter.
The widening extent of this behavior is largely a post-World War II phenomenon, partly because so much more money went into the “medical industry” (a term rarely used before 1970) after the implementation of Medicare in 1965. Some physicians and others in various aspects of health care gradually stepped up to the trough (filled directly by doctor's orders).
Divergence from Earlier Focus of Medicine on Common Good First
These people built practices, departments, businesses, health systems, and personal lives that became dependent on sustaining a focus on profit margins and personal gain, too often at the expense of the common good. This is a divergence from the historical focus of medicine largely on the common good first and personal and professional welfare second.
And as I write this, many states are planning to shrink their Medicaid programs because they can, based on the Supreme Court's ruling. They also claim they will refuse billions of dollars in federal money from the Affordable Care Act available to them for expanding Medicaid. What happens to the Medicaid-eligible population with no insurance is not mentioned, despite this being a time of economic stress that hits lower income people the hardest.
I believe that Christopher Lasch would say that the intense capitalism driving today's “medical industry” has made it become viewed by politicians, insurance companies, and many caregivers in the same way they view the auto or computer or bedding industries—i.e., as just another business. But medicine is not like making cars. We could do without a new car, but when we have an episode of illness, postponement or foregoing care can lead to dire consequences.
We cannot have a decent, thriving society without affordable medical care and help for those unable to help themselves—a key component of any modern definition of the common good.
Above all other considerations, the soul of medicine is the bedrock commitment to use our professional expertise to help those who cannot help themselves. Gaming the system, overcharging for pharmaceuticals, ordering unnecessary diagnostic tests, and other scams mean someone has to pay for it, and can you guess who that is? It's the patients, of course, either directly or by higher insurance premiums or co-pays.
At its best, medicine is the anti-Narcissus. We should not demean our profession and the trust given to us by society by becoming modern-day versions of Narcissus.