A stressful job: are surgeons psychopaths?

Doctors are subjected to a high level of psychiatric morbidity, with literature showing that various factors for stress are present in their roles: long working hours,^1,2 night shifts, divorce,³ being a surgeon,⁴ medical lawsuits⁵ and failing to meet continuing medical demands.⁶ It will therefore not be too surprising that some of the traits associated with a psychopathic personality (eg preternatural calmness under pressure, or apparent indifference to human suffering when making life-or-death decisions) are perhaps selected out in those who rise to the top of our profession. Could this mean that psychopaths are over-represented among the ranks of hospital consultants versus the general population? You could hypothesise further that the career advantages conferred by this personality type would result in a higher incidence among teaching hospital consultants versus district general hospital (DGH) consultants.

A search of the worldwide scientific literature, however, has found no studies assessing the psychopathic personality traits among doctors in teaching and district general hospitals. The present study was designed to compare the various personality traits among senior doctors across six hospitals and to find out which traits predominate.

Methods

The personality traits were assessed of 172 doctors from 3 local teaching hospitals and 3 DGHs, using the short form of the Psychopathic Personality Inventory (PPI-SF) as an online questionnaire.⁷ Ethics approval was unnecessary as the participation process did not involve patients and was voluntary. In November 2012, 420 consultant members of staff at the 6 hospitals were sent a covering letter with a request to follow the embedded link to the questionnaire. Only those wishing to participate completed the questionnaire.

The PPI-SF was used as it is a validated short version of the full-length inventory.^7,8 The Psychopathic Personality Inventory (PPI) is employed regularly in the assessment and quantification of mental health. It is divided into eight subscales (Table 1). The PPI demonstrates validity in both forensic and non-forensic settings, with the added benefit of the short form having only 56 questions compared with 187 in the longer format. There are four possible responses to each of the questions: false, mostly false, mostly true and true. As a result, the PPI-SF scores from 56 (weakest suggestion of psychopathy) to 224 (strongest suggestion of psychopathy)....