Why are there so many psychopathic surgeons?

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I have never inserted a catheter into a patient's femoral vein. In the unlikely event I ever have to perform this procedure, I hope I don't screw it up as epically as the unnamed doctor assisting with Clayton D. Lockett's execution last April.

What's notable about this doctor's dismal failure, described by the warden who witnessed it as a "bloody mess," isn't just that he hit the nearby femoral artery instead of the vein. Nor is it that his misdirected first attempt caused the fatal drugs to leak into the surrounding tissue instead of traveling through the bloodstream to kill the prisoner. What makes the whole sordid affair all the more appalling is that during the process of botching the execution and inflicting undue suffering, the doctor in question got blood on his jacket and then complained that he'd better get paid enough to buy a new one.

That distant whirring sound you hear is a long-dead Greek physician spinning in his grave.

Whether or not Hippocrates ever actually said "First, do no harm," the axiom is central to medical ethics. Though medical treatment often has effects that can be harmful to patients, as physicians we are bound to mitigate those harms to the best of our ability. Given that no harm is greater than killing someone, it is generally considered unethical for physicians to participate in executions, even though some still do.

No matter the motivations that inform the willing participation of some doctors in putting people to death, it is horrifying to consider someone more concerned about a blood-spattered garment than the suffering of the person whose blood is being spattered. Confronted with examples like this, or doctors complicit in torture that its defenders pretend was for "medical reasons ," it makes one wonder about the truly damaged individuals who somehow find themselves in charge of caring for patients.

The good news is that, according to a psychologist at Oxford University, most doctors aren't psychopathic. On a list compiled by Dr. Kevin Dutton, physicians are among the 10 professions least likely to be psychopaths, defined as those with a personality disorder characterized by impaired empathy, manipulativeness, shallow emotions, and other antisocial tendencies. We share space with teachers, nurses and (who knew?) accountants on the "non-psychopath" end of the professional spectrum. Comes as rather a relief, I must admit.

The bad news is that our colleagues in the operating room don't fare quite so well. Surgeons - for some reason categorized separately from other doctors - are among the 10 psychopathic professions, though they do get edged out by lawyers, media workers, and CEOs for the top three spots.

I cannot say I am wholly surprised by this.

Among all the textbooks I had for my medical school rotations, the one I had for surgery was unique in having a short section devoted entirely to dealing with the sometimes prickly temperaments of those who had entered that field. Though I encountered some challenging personalities in various other specialties, the only person in my adult life I've ever heard utter the "n-word" in conversation was a surgeon, blithely dropped in a teaching session about the adrenal gland, of all things. He took my angry objection poorly, later referring to me as a faggot in front of yet another medical student, who happened to be a friend of mine. The lack of disciplinary action by the school in response to my complaint is why I don't give the alumni fund any money to this day.

It's important to note that the majority of surgeons, no matter where they may rank compared to other professions, don't have personality disorders. (And yes, here's the disclaimer that some of my best friends from medical school went into surgery.) The competitiveness and high-stakes environment of a surgeon's world may be a draw to medical schools' psychopaths, but that doesn't mean the label applies to all of them.

Despite general good intentions, however, even good physicians can deliver care that falls short. In the weeks following the birth of her son Edmund, a sweet little guy with a rare genetic syndrome that requires lots of specialized care, my best friend Elizabeth shared many stories with me of doctors who were by turns callous, dismissive, or indifferent. It seemed a week didn't go by when I wasn't apologizing on behalf of my profession for one thing or another. But the prize has to go to the pediatrician who, when praising her parenting, suggested that as a plausible alternative she might well have considered smothering him. My desk still has the dent from where I hit my head against it when I heard that one.

Psychopath or not, perhaps the greatest threat to a doctor's ability to care for patients properly is forgetting their underlying humanity. Some people can be particularly unpleasant or demanding, and over time dealing with them can take its toll on our willingness to treat them as well as we could. As tempting as it may be to write them off as undeserving of our efforts, a pitfall some physicians seem alarming happy to jump into, we are obliged to do otherwise. If you've started thinking of patients as sub-human, it's time to reconsider why you're trying to take care of them in the first place.

When we learn of medical providers who, by virtue of their profession, are given leave to inflict suffering on others, it comes as a particular shock. Torturing or killing people is a perversion of the work we are meant to be doing, and a betrayal of the ideals that should undergird any physician's practice. But even as we recoil from the actions of the worst outliers in our profession, we must always recognize our own ability to do harm. Even the best of us can hurt the people who come to us for care when we forget that our foremost obligation is to them.