With the awareness of saying something stupid comes learning and even at times insight. This awareness doesn’t erase one’s stupidity, but it may make one smarter for the future. I was recently talking with a friend about physician leaders and out leaked an incorrect generalizing comment. I suggested that physicians who tend to be self-centric in their view if not narcissistic aren’t good leaders. What I meant to say was that a lack of broad perspective is a barrier to being an effective leader, however, it may not be a barrier to positive contributions to organizational learning and problem-solving, not to mention being a good physician.  Dogmatic views and attachment to narrow perspectives can interfere with good leadership in complex, diverse and uncertain environments. However, in certain situations those qualities can be helpful. Not being a good listener is a problem if your leading a diverse group through complex issues, but good listeners (aka good leaders) like people who will speak up, and that’s were physicians, even those who are somewhat self-serving can contribute facts, ideas and insights.

As I tried to recover from my stupidity, a thought popped into my head. Could narcissistic physician leaders start to lose their effectiveness the more broadly their leadership asks them to think and function? What if they contribute quite well until they get to the executive leadership level? In 2012 Justin Menkes wrote a short article for the Harvard Business Review entitled: “Narcissism: the difference between high achievers and leaders.” He suggested that high achievers who are also narcissists can do very well to a point, however, at the executive level they can sink your company. The narcissism just gets in the way.

In 2000 and 2004 in the Harvard Business Review, Michael MacCoby published “Narcissistic leaders: the incredible pros, the inevitable cons” where he suggested that narcissistic leaders do have the advantage in certain situations, specifically where there is chaos or opportunity for innovation. Implied but not specifically stated in his article is that you have to be really good at what you’re doing (e.g Bill Gates, Jack Welch, etc.). Healthcare may be going through a lot of change, and some would claim chaos, but at the heart of providing health care is the patient, a person who doesn’t need chaos or change, they need high-reliability. Narcissism won’t get you that at the micro- or macro-system levels. Even beyond health care delivery, narcissism is potentially dangerous in healthcare. Just consider the case of Theranos and Elizabeth Holmes. Narcissism, even if you think you’re doing a good and just thing, gets in the way.