Doctors are at high risk for becoming bossy — especially towards their colleagues. Otherwise kind, rational doctors can become tyrants in the face of chaos and fear.
If we were hunting for bossy docs, we might start with medical leaders and physicians in niche specialities.
External Causes
Leadership carries a high risk for bossiness.
Some medical Chiefs gain humility from caring for sick complex patients. It shapes their approach to leadership. Unfortunately, many forget their failures. Others never learned in the first place.
Many Chiefs of Staff have never seen sick patients at all. But as Chief, they see all the medical disasters and deal with the most difficult doctors. They run the risk of thinking all docs are difficult and basically failures waiting to happen.
Like leadership, some specialities are also more likely to foster bossiness. Niches with low medical risk and high paternalism present the biggest risk. These docs never see sick patients but spend all day giving definitive advice.
However, chiefs and niches do not explain enough. Not all docs become bossy from being chief or a member of a medical niche.
Blaming bossiness on a chief-niche explanation assumes an external locus of control: bossy docs were victims of a bossiness-inducing environment.
7 Reasons Why Some Doctors Become Bossy
We could also assume an internal locus of control. What goes on inside a doctor to make him/her so bossy?
A. Good intentions
Children torture kittens with cute outfits, “Because Kitty likes it.”
Parents torture children with cute outfits, “Because it makes you look smart, dear.”
Politicians torture citizens with things they would never choose themselves — so-called merit goods.
Doctors do the same.
“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies.
The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
CS Lewis
B. Habit
Many doctors give orders for a living.
A group of us asked a young cardiac surgeon about life with his new baby. Had he changed any diapers yet?
In a heavy accident, he said:
“Oh sure. I call my wife. She comes. I hold out my hand, like this.”
He held out hand, palm up.
“Then I say, ‘Wet wipes!’ And she give it.
‘Lotion!’ And she give it.
‘Diaper!…’
Just like surgery.”
C. Prudence
Most doctors are practical. Especially in procedural specialties, we use the shortest path between intervention and outcome.
Barking orders wastes less time than decision by committee.
D. Ignorance
Doctors do not study leadership to become doctors. Aside from loads of math and science, most doctors do not study much of anything else. Medicine demands total commitment without room for non-clinical things.
E. Hubris
Many docs assume they are so much smarter than everyone else that they should be the boss.
F. Arrogance
Arrogance goes beyond hubris. Some doctors cannot tolerate anyone else in control. They hold others in disdain.
G. Maleficence
A few doctors hate their colleagues. They want to cause pain. A position of power, such as Chief of Staff, lets them exercise their wish.
Hubris, arrogance, and maleficence are less common, but we have to admit they exist.
Helpful Bossiness
Many situations demand a level of control which looks bossy. In this sense, bossiness may not be bad in itself, only when misapplied.
It is a bit like debridement. Dead tissue needs to be cut off to save the healthy bits underneath. Cutting too little is bad. Removing vital parts is worse.
Fortunately, only rare wounds need major debridement. Most need a light cleaning or nothing at all. Too often people use bossiness when it is not necessary — like debriding healthy tissue.
Internal Cause, External Opportunity
Pandemic chaos and fear created a petri dish for bossiness. It turned some otherwise rational doctors into dictators.
COVID gave literal or social media microphones to some very bossy docs. Politicians deferred to a handful of experts. No one dared speak against them. The few who did faced punishment.
As pandemic fear subsides and normal chaos returns, we should ask:
Who were the bossiest docs?
Who needs counselling after losing their COVID pulpit?
Can we protect ourselves from bossy docs in the future?
Some docs are just born bossy. They use power to work out their own issues. But we don’t need to let them ruin our lives in the process.
Photo credit: Pixabay
The C S Lewis quote was the best.
Well meaning bosses have caused a ton of pain.
Hopefully it stops now…
Hey, Ram … glad you liked that one.
Lewis ends the paragraph with this:
“To be “cured” against one’s will and cured of states which we may not regard as disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals.”
As someone joked: the beatings will stop when morale improves.
No one said we can’t push back.
Thanks for posting!
I attended an excellent but rather Spartan school in Wales and was told. “ You were born to rule, but before you learn how to give orders, you must learn how to take orders”…one became the servant of a senior boy, making his bed, cleaning his kit (rugby/ Cadet and polishing military brass and boots so that you could see your face in it, our school regiment fought at Rorke’s drift).
In those days corporal punishment and humiliation was the norm with sadistic prefects and teachers skilled at the subject.
One learns something , when at the bottom of the ladder getting ones nose rubbed in that you can learn in no other way and carry with you for the rest of your life, no matter how “high “one rises…you learned to take the hard times and to learn compassion, to this day I cannot stand bullying, the mal treatment of those below one on the ladder, seeing a server treated badly in a restaurant makes the blood boil…medicine had a rather brutal career ladder with brutal hours that the moderns cannot conceive…housemen/ interns were thrown into the battle poorly prepared and expected to “ swim” , in Britain at the minimum wage ( in Canada to do it for free , your learning from the masters was your payment) …PARO arrived to the rescue with my arrival in 1968.
That generation when , in leadership, were far more understanding of the trials and tribulations of those working under their authority and we’re far more forgiving….the moderns not so.
There is a generation coming up that have never experienced real hardship, I recall Ghandi stating that what troubled him about the upcoming younger generation was , despite their superior education, the “ hardness of their hearts”.
Fantastic bit of history, Andris. Thanks for sharing it.
When I went through university in the 1990s, it was common to hear this same story from our profs. Those who had gone through it seemed to have a resilience unavailable to the rest of us. It almost seemed to flow from a “to prevent war, train for battle” approach.
Starting in the 1970s, people worried about nuclear war — annihilation. Why bother becoming tough when it will all end in a flash anyways? Better to focus on a strong self image than a courageous self sufficiency.
We’ve lost an understanding of authority and replaced it with a nit-picking bossiness.
Thanks again for taking time to read and share a comment!
This discussion could go on for a long time except for the fact that many who respond likely do so because they agree and therefore I have little to add. I sure appreciate the comments thus far but also know I am allowed on this forum to debate which has been taken away from us, somehow??, since the start of the pandemic. We all have some character flaws, nature or nurture, and these change and develop as we “grow”. Would be Physicians start off often with personalities that tend to like being in charge and independent and therefore a bit bossy and even narcissistic. The group that become and remain good doctors that look after patients, usually and quickly become somewhat humble (learn by there mistakes) and willing to discuss/debate. Those that don’t look after patients, like public health doctors???
Brilliant redirect, Graeme. You’ve pulled us back to the thread.
What “has been taken away from us, somehow??, since the start of the pandemic”?
As you say, docs need a degree of bossiness, especially in acute care. And we all risk narcissism and a dozen other failings.
How can we amplify the humility/openness required to do real medicine?
How can we maintain the essential (in my mind) requirement for medicine in the next pandemic?
I heard someone say recently that, “Scientists are proud of their humility.” They are proud of the limits of their knowledge. They proclaim that this is the best we know today, but it will surely be better understood tomorrow.
A large element of public trust rests on this ‘pride in humility’ aspect of science. Patients can trust someone who says, “I am not entirely sure, but this seems like the best path forward. Either way, I’m here for you.” They cannot trust (or respect) someone who says, “Do it or else.” No doubt, people with guns (police, military) have to say this. But doctors should not.
Thanks again! I worry about the next pandemic. I hope we do not lose our minds like we did with this one.
Cheers