Your success is our success

Or is it my success?

Some years ago, I had a great chemotherapy nurse working with me who was older, and as we say, “non-traditional.” He had had a whole different career as a baker for many years prior to going to nursing school. Being a nurse was a major life change.

Many healthcare providers are non-traditional, even physicians, and in general bringing their different life experiences to their healthcare practice can be very beneficial as contrasted to those providers who have only ever known medicine and may not relate to patients who never did. I was more what you would consider traditional, though I “majored” in extra-curricular activities in undergrad, and have had numerous non-medical jobs/experiences. I can, for example, drive and parallel park a Greyhound Bus….

One day he and I were discussing how to help patients stop smoking. As the conversation progressed, I reminded him that he was a manipulator, as are all of us working in healthcare. He appeared quite bothered by this idea, and said he did not think that was true at all. As we discussed positive manipulation – to promote positive change or help others and without personal gain, I emphasized that such power so readily given by patients is to be taken extremely seriously, responsibly, and cautiously.

We discussed that for our de facto role fidelity in healthcare, many patients subconsciously expect this from us, whether verbally or by example.

Over the years I’ve known doctors and many nurses who smoke. I’ve also known many, many anti-vaxxer healthcare providers, from pharmacists, to nurses, to doctors. I am aware from a survey I did years ago at the Kaiser facility where I worked that the vast majority of physicians do not themselves have Advance Directives. What subliminal messages are they sending to their patients? How sincerely can they recommend positive patient behaviors when they themselves do not? Can patients sense when they are not sincere? You and I both know the answers to those questions.

As above, as we have these numerous conversations with patients, the goal is to guide them to effect positive change. Limited examples of positive changes are stopping smoking, losing weight, exercising, stopping drug and alcohol abuse, preventive care, managing anger, and even improving self-esteem.

...But occasionally, it just seems like you’re getting absolutely nowhere. Talking to a brick wall. Falling on deaf ears. Going in one ear and out the other....

Then, a slight prickle goes up your spine. Some call them hackles. As in, “My hackles went up….”

Yes, I have a yellow Labrador Retriever. This is not he.

Be aware of and acknowledging that feeling is critical to a successful intervention in this situation and will send you in a very different, helpful direction.

In my experience, nothing results in this sensation besides narcissism. There it is. I said it.

As with any implicit bias, it is not an option as a healthcare provider to walk away when encountering a narcissist. You must check your implicit bias at the door, get in there and give it your best effort.

Narcissistic tendencies present a very unique problem in medicine, affecting every possible health condition including preventive health.

If I think Drug X is a particularly effective medication for the condition you have, I might present the data as something like:

“There are several truly impressive, large, randomized, double-blind studies that show this medication works for a vast majority of people with this condition, and their benefits appears durable without them experiencing appreciable side effects.”

Sorry, but I can tell you that approach will not fly with anyone with narcissistic traits, even if I could reassure them that the medication was brought down from Heaven by Jesus himself.

Behold, The Paw of Dog. Yes, these paws belong to my Labrador and Berner.

Ethically, lying is not an option, nor is it even necessary. If I am to be an effective healthcare provider for these patients, I must make it personal -- personal pronouns, that is.

“I think from all the strong data I have reviewed for this medication that it will work very well for your condition, and the benefit you see is very likely to be durable, without you risking significant side effects.”

Amazing. Works almost every time.

Maybe all my time in the Navy under Don’t Ask Don’t Tell was just practice for watching my pronouns?

Pronouns abound, they are everywhere you actually look – I, you, he, she, it, we, they, them, their, me, him, her, us, his, hers, its, theirs, our, my, mine, your, yours.

You, your, yours? These are really the only pronouns that will help you get your point across to someone with narcissistic traits.

Me, my, mine – you’ll notice these are the preferred pronouns of narcissists.

So, no, I’m not talking about the MAGA-triggering word “pronoun,” which actually refers to how a person prefers other people to address them.

I’ve often said I don’t care what your pronouns are, as they do not affect me in the least. If you tell me your pronouns are he/him/his, that’s how I’ll refer to you. If you tell me your pronouns are “self-absorbed, white nationalist, and christofascist,” that’s how I’ll refer to you.

While it is tempting to diagnose Trump’s (and many of his fanatics’) apparent psychologic disorders, that is considered both unreliable and unethical (Known as The Goldwater Rule -American Psychiatric Association, 1973) without personally examining the patient. Does he appear to have narcissistic traits? Very much so. Does he have Narcissistic Personality Disorder? That I cannot say professionally as I have not examined him personally.

By the way, it is not uncommon to have multiple personality disorders concurrently. That also seems likely.

So, to recap, and some further tips for working with people with narcissistic traits:

· Avoid “they/everyone/everybody” statements.

· Use “you will benefit” statements, not the generalizing “this works well for most people.”

· Avoid anecdotes. Those reflect other people’s experiences, which is never compelling to narcissists.

· Collaboration should demonstrate that their input is valued and even sought.

· Sincere, positive reinforcement of even the tiniest degrees is important for their constant need for validation

· Stay truthful and sincere, while acknowledging their concerns, but do not feel compelled to validate false statements.

· Do not feel the need to “be right” about exaggeration but do gently counter hyperbole with positive rather than negative statements.

· Specifically acknowledge their repetitive statements (which can indicate they think you are not listening, even subconsciously) by demonstrating you understood their message.

· Avoid being perceived as patronizing.

· Stay calm and professional.

· Humor is rarely helpful to diffuse situations with narcissists. Like anecdotes, humor suggests many people find your statements funny, and they are not like the many.

· Establish expectations to communicate, and do that clearly, concisely, though with boundaries. Take 10 minutes or more to return that non-urgent message even if you have the time right now.

· Avoid getting drawn into personal discussions or emotional debates, even if the person is provocative, and redirect quickly with a statement that confirms your interest in their well-being.

· For any person you might see again, keep detailed notes of conversations – that you would have no reservation sharing with the person later if asked. Avoid using perjoratives in your notes.

So, yeah, that’s some of the “art” of medicine.

And how does all of this translate for how you can more positively interact with MAGAs who appear to have narcissistic traits, including your obnoxious drunk Klan uncle?

With exactly these same approaches.

Just watch your and their pronouns and you’ll be fine.

“You got this.”

Your blood pressure will thank me later.

And you probably thought this whole woke pronoun thing was ridiculous. They do. I know it’s not, and now you know it’s not.