Surgeons are often perceived as confident, decisive, and highly skilled professionals. Their unique personalities set them apart from non-surgeons and other medical specialists. These differences can sometimes lead to challenges within the healthcare system. Research suggests that certain personality traits, including high levels of conscientiousness, extraversion, and risk tolerance, are common among surgeons. While these traits are critical for success in the operating room, they can also show as narcissism. They might appear as hostility and stress too, particularly in high-pressure environments. This article critically examines the surgeon personality. It looks at their strengths and potential pitfalls. The article focuses on the dark triad traits of narcissism, Machiavellianism, and psychopathy that gives them the ‘God-complex’. Also find out how gamers can make better surgeons in this article.

The “Surgical Personality” and Its Traits

Several studies have identified key personality traits that distinguish surgeons from non-surgeons. The Five-Factor Model (FFM) of personality is often used to assess these traits, including conscientiousness, extraversion, agreeableness, openness, and neuroticism. Surgeons often score:

• Higher in conscientiousness: Reflecting their attention to detail, discipline, and work ethic.
• Higher in extraversion: Demonstrating confidence, decisiveness, and social dominance.
• Lower in agreeableness: Suggesting a more competitive and assertive nature.
• Higher in risk tolerance: Critical for quick decision-making under pressure, but potentially linked to risky behaviours.

While these traits are beneficial in surgical settings, they may come at a cost. Lower agreeableness can lead to interpersonal conflicts. High risk tolerance may increase the likelihood of questionable decision-making in non-critical situations.

The Dark Triad: Narcissism, Machiavellianism, and Psychopathy

The dark triad consists of three overlapping yet distinct personality traits: narcissism, Machiavellianism, and psychopathy. These traits are often linked to manipulation, self-centredness, and a lack of empathy. Surgeons as a group generally show lower levels of dark triad traits compared to the general population. Still, certain subsets show elevated levels of narcissism. This is particularly true among male surgeons and younger trainees.

Narcissism in Surgeons

Narcissism is characterized by grandiosity, a need for admiration, and a lack of empathy. It has been observed in a significant part of surgeons. Studies reveal that:

• 33% of surgeons show narcissistic tendencies.
• Male surgeons score higher in narcissistic rivalry compared to female colleagues, reflecting a more competitive and defensive nature.
• Younger surgeons, particularly those still in training, show higher levels of narcissistic admiration and rivalry.

A degree of narcissism can foster confidence and leadership. Yet, excessive narcissism can cause disruptive behaviour. It can also result in interpersonal conflicts and impaired teamwork. Furthermore, narcissism has been linked to increased hostility and stress, particularly in challenging environments.

Machiavellianism in Surgical Settings

Machiavellianism is marked by manipulation and strategic deceit. It includes a focus on self-interest. It is less commonly studied in surgeons but remains a relevant concern. In highly competitive surgical programs, individuals displaying Machiavellian traits may focus on personal success over teamwork and ethical considerations. While this can drive ambition, it can also foster toxic work environments and undermine trust within surgical teams.

Psychopathy and Risk-Taking

Psychopathy is characterized by impulsivity, a lack of remorse, and emotional detachment. It is perhaps the most worrying of the dark triad traits. Surgeons generally score low on psychopathy compared to the general population. Nevertheless, specific behaviours, for example risk-taking and reduced emotional sensitivity, can align with psychopathic personality tendencies. These traits may enhance performance in high-stress situations but can also contribute to burnout, disruptive behaviour, and diminished patient trust.

Bullying, Stress, and Hostility in Surgical Training

The demanding nature of surgical training often exacerbates negative personality traits. Research highlights a troubling association between bullying during training and the development of hostility and stress in surgeons. Key findings include:

• Bullying experiences: Surgeons who experienced or saw bullying during training reported higher levels of hostility and perceived stress.
• Work-life imbalance: Excessive workloads and extended hours negatively impact surgeons’ mental health, further amplifying stress and disruptive behaviour.
• Meaning in life: Surgeons who reported a strong presence of meaning in life experienced lower levels of hostility. They also experienced less stress. This highlights the importance of personal fulfillment in mitigating negative traits.

These findings highlight the need for systemic changes within surgical training programs. It is essential to tackle bullying. Programs should also promote mental health and encourage healthier work environments.

The Impact of Personality on Patient Care and Team Dynamics

The “surgical personality” is often celebrated for its strengths. These include decisiveness and confidence. Yet, it can negatively impact patient care and team dynamics when dark triad traits come into play. Disruptive behaviors, including arrogance, lack of empathy, and poor communication, can:

• Compromise patient safety by hindering collaboration and decision-making.
• Foster toxic work environments, leading to burnout and reduced team morale.
• Undermine trust between surgeons, colleagues, and patients, ultimately affecting care quality.

Addressing these challenges requires a shift toward greater self-awareness. Surgeons also need emotional intelligence. Institutions must support professional development and mental health.

Balancing Strengths and Weaknesses

The surgeon personality is a double-edged sword. Traits like conscientiousness, extraversion, and risk tolerance are critical for surgical success. Nonetheless, they can also manifest as narcissism, hostility, and stress under challenging conditions. The presence of dark triad traits, particularly narcissism, highlights the need for ongoing self-reflection and professional development among surgeons.

Efforts to tackle bullying are essential for mitigating the negative aspects of the surgeon personality. Improving work-life balance and fostering a sense of meaning in life are also crucial. By promoting emotional intelligence, teamwork, and supportive work environments, the surgical profession can strike a balance between its strengths and its potential pitfalls, ultimately improving both surgeon well-being and patient care.

References

El Boghdady, M., Ewalds-Kvist, B.M. Surgeon’s narcissism, hostility, stress, bullying, meaning in life and work environment: a two-centered analysis. Langenbecks Arch Surg 408, 349 (2023). https://doi.org/10.1007/s00423-023-03068-z

Vittoria Bucknall, Suendoss Burwaiss, Deborah MacDonald, Kathy Charles, Rhys Clement. Pathologic personality traits in health care. CMAJ Dec 2015, 187 (18) 1359-1363; DOI: 10.1503/cmaj.151135

Whitaker, M. The surgical personality: does it exist? The Annals of The Royal College of Surgeons of England 100, 1 (2017). https://doi.org/10.1308/rcsann.2017.0200

Schwartz, R. W., Barclay, J. R., Harrell, P. L., Murphy, A. E., Jarecky, R. K., & Donnelly, M. B. Defining the surgical personality: a preliminary study. Surgery, 115(1), 62-68 (1994).

Drosdeck, J. M., Osayi, S. N., Peterson, L. A., Yu, L., Ellison, E. C., & Muscarella, P. Surgeon and nonsurgeon personalities at different career points. Journal of surgical research, 196(1), 60-66 (2015).