Tuesday, June 19, 2012

Psycopathy In Health Care Organizations

Years ago, the Disease Management Care Blog tagged along as a minor player to a high level strategic meeting involving a pharmaceutical company and a provider organization. The senior leadership egos on display barely competed with the meeting room's spacious view of the Manhattan skyline as our group was hosted over yummy pastries and coffee by a good looking, gregarious, gracious, intelligent and obviously "connected" pharma executive.

The meeting progressed quite nicely until a coffee break supervened and the DMCB found itself alone in an anteroom with the host. Caught up in the enthusiasm of the moment, the DMCB parroted one of the meeting's nostrums about the internet. The executive turned and hissed at the DMCB's stupidity with dripping contempt, turned and walked out. Minutes later, the meeting restarted as if nothing happened.

That was just one of the DMCB's many encounters with an organizational psychopath. Unable to have experience any interpersonal "connection" with anyone, these soulless persons use the people around them to pursue the more tangible rewards of power, financial gain or amusement.  Excluded from the social web of human relationships, psychopaths can't access a moral compass.  As a result, they turn to social mimicry to charm, shame or bully anyone in the pursuit of their goals.  Everyone that surrounds them is a either a means to an end or,in the case of the DMCB, dirt.

While the more famous psychopaths are sadistic murderers, they're the exception.  Most of them coldly calculate that they don't need violence to achieve their ends. Deceit, predation and manipulation are more than enough while they pursue their goals in the cubicles down the hall and the offices upstairs.  And as they click along, these Sandusky-esque time bombs are often recognized too late.

Here's the DMCB's four  rules on how deal with organizational psychopath:

1.  That ill-defined "feeling" that you have that something's wrong with that person? You wonder if it's bad parenting, drugs, mental illness, curious flattery or an inflated egoTrust your instincts and include psychopathy among the possibilities.

2. Don't be surprised when you uncover the extent of the dysfunction.  The prevalence is at least 1% and their toxicity can bring a team, a department and even an organization to its knees before you realize what's happening.

3. The infamous Milgram experiments found that persons in positions of power can lead decent people to do awful thingsQuestioning authority is a good thing. If you do it, you deserve credit. If one of your reports does it, they deserve protection.

4. Stay away, contain and remove, preferably the latter - even if it means you.  Warnings and counseling will not change their underlying motivation in any appreciable manner.

The DMCB is happy to report that the meeting didn't lead anywhere and that it was wiser for the experience. 

That's why, years later, its skin crawled in a medical meeting hotel bar. 

Following a standing ovation for a plenary session presentation by the charismatic CEO of a very successful health care organization on the merits population health, the electronic record and systems integration, the DMCB found itself behind him and one of his minions trying to get a cappuccino. English was not the hapless server's primary language and she struggled with the barista's brewing details. The CEO's cold scorn and hateful disdain were radioactive while his companion's nervous silence signalled that more than just impatience was at work.  The guy on stage just minutes before was an impostor.

Yes, it really did happen and yes, he's still out there.


Sarah Y said...

The Milgram experiments were interesting and disturbing but they had a more complicated result than simply power equals evil. In fact people were more likely to disobey direct orders. They did the most damage when talking themselves into it. This Radio Lab episode goes into it in depth: http://www.radiolab.org/2012/jan/09/

I think that simple interpretation says more about our tendency to quote the study in pop culture then anything one way or the other about psychopathy.

Jaan Sidorov said...

Hi Sarah! Yes, when physicians detour into psychology, the professionals always find that the docs never quite capture all the nuances. Your point is well taken but I think I got the basics right: charming proximity by persons in authority results in a greater frequency of bad behavior, whether the victims are talked into it or they talk themselves into it.