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There is no doubt, there is something called a "surgical personality". A particular 'type' of person that excels at this specialism. This topic is explored in a new book by Dr. K. Dutton. 

This book draws positive comparisons between the attributes of antisocial psychopaths, the serial killer profile, and the “functional psychopaths” among professions such as surgeons, high-powered executives, and politicians.

The key shared characteristics between the serial killer profile and the successful professionals are ruthlessness, charm, focus, mental toughness, fearlessness, mindfulness, and action—dubbed the “Seven Deadly Wins.”

The author makes the case for the evolutionary aspects of the nonviolent psychopathic profile in the modern world as an effective adaptive strategy leading to success and “getting what you want.” The author suggests that the difference between the violent and predatory psychopath and the functional psychopath is how the psychopathic characteristics are “dialed up” and in what context.

 

The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success

by Kevin Dutton, Ph.D., New York, Scientific American/Farrar, Straus, and Giroux, 2012, 261 pages, $26

Psychiatric Services 2013; doi: 10.1176/appi.ps.640505

  • Comments (7)
  • I followed a Pod once for awhile who would make it sound like to the patient that it was surgery or nothing at all.  After a very words, he'd demandingly say, and I mean regardless of the patient's health status, age, or initial wishes upon presentation to clinic, he'd ask them flat out- "what do want to do?"  And when they would say either, I don't know, I have to discuss it w/ someone (family member), I live alone, or no I don't think so, he- the Pod, would retort by stomping his feet and slapping his knee, and say ok, you can just go to the dollar store and buy some pads, get your shoe stretched (no script given nor where to get this done), and tell them you better think about it as it will only get worse.  This would often be for some elderly, diabetic, with poor circulation whose already had so many surgeries, recovery periods, has gait disturbance if not imbalance, and only wanted palliative care for his corns, callouses, & bursitis, as well as dermopathies.

    I will tell you this for sure: I was embarrassed to be in those exam rooms.  I would not want that doc for any member of my family.  His postop complication was high, and I spent alot time cleaning them up.  Furthermore, it gave me no end of stress as it put me into serious ethical quandries.

    Just wait till I write up the bilat forefoot burn patient I cross-consulted on that I advised to be admitted but was kept as an out-pt only to milk the superbill for padnet, dermagrafts, out-pt visits, etc.  I was told to stay away from that pt after my note was submitted.  (m&M! city)  My ethics are too big for me I guess.  That's what I get for watching to much Star Trek, having the parents I did, and also the Professor of Military Science (ROTC) I had.

    Now, we've all had cases that did not go the way we wanted them to, especially in fragile patients... but when it's time to call for surgical admission, ful-court press, lots of consults, tests, and get all the right diagnoses on the chart, IT IS TIME.  But there is also such a thing as knowing one's limitations: the mark of a good Podiatrist, as I was taught.  But some never learned that, apparently.  WORDS TO THE WISE... IF YOU BE SO.  (WISE, THAT IS, AND OPEN TO LEARNING, WHICH REQUIRES A MODICUM OF HUMILITY.)

    That's all I know about that.

    WG

  • Alex - to be clear I am not disagreeing with you. A surgeon can also "sell" a patient who is in pai n and does feel it is the right thing to do. Many patients have fear of the unknown. When you help make the patients decision are you not essentially "selling" them the surgery????? The ones that do unnecessary surguries...I don't know if they are psychopaths as much as they are $$-&@8's!!If you know what I mean. They do it for the money who is kidding who.
  • Is it not self sering, or pathological, to "sell" a bunionectomy to a patient who i snot in pain? I mean, let's say a person has a whopper of a bunion with an IM of 18 but is in no pain and doing well with orthopedics shoes. Why talk that person into getting surgery? If you do the surgery and the person has a beautiful outcome, yes you may have improved their quality of life and they can get into different shoes, but the surgery was done to "get numbers" or "get paid". The surgery was done for the surgeons benefit or interests and NOT for the patient's best interest. In other words, even though a "good thing" was done - it was for all the wrong reasons. For sure an ethical dilemma in my opinion. Isn't the PATIENT first? A Is our society not striving towards "Patient centered care"? Furthermore, et's not even open Pandora's Box by speculating what may happen if there is a complication. How many stories have we all not heard or read about regarding lost malpractice claims for "unnecessary surgery".

  • I don't think "selling" a surgery makes a psychopath. I do think there is something wrong with performing unneccesary surgery. I was asked to perform a case by a resident that came through the hospital ER. It was an osteomyelitits of a distal phalanx.

    My response to the resident why are you asking me to do the case? The chief here gets everything. He replied the Chief told him to ask me. I was confused, until the resident informed me the patient had no insurance.

    I took the case nonetheless. The plan was a hallux amp. the distal phalanx was shot, we had to go back one joint and the patient was non-ambulatory so rather than leaving the base of the proximal phlanx and wondering if clean or not I decided to take off the toe.

    During the case the resident asked me if we could take some of the first met head. I turned to him and asked him why he would want to do that? his reply was "because we need first ray cases".

    I turned to the resident and told him i will pretend I NEVER heard that and that no way in hell would I take any more bone off. The resident made not one, not two but three attempts to actually take an instrument in his hand and try and take a snipet of bone he could call a biopsy or whatever to log his case. I literally had to push his hand out of the way and without making a scene (which in retrospect would of been better) let him know he was a resident and needed to "step down".

    Was he psychopath? I don't think so, I think he was a moron. A moron mixed up in this silly numbers game that the Council of Podiatric Medicine has these guys going through. he was motivated by fear of not making numbers and not getting a certificate. The psychopath was the Chief of the service who came yelling at me that I should of "taken the bone". The psychopath was the Chief who fired me from my clinic job for "not taking the bone".  

  • Interesting concept. It sure sounds plausible. I like the "7 deadly wins" tag line though - very catchy. I think I may quote it in a subsequent motivational speech.

    Also, to look at things from a different angle, many criminals /psychopaths are actually brilliant people. It's a shame they use their intelligence / "7 deadly wins" for nefarious intent.

    This further brings me to think of past acquaintances. I remember old attendings who could talk anyone into having a bunionectomy or other surgical procedure. I don't know, maybe they loved doing cases or  they needed to make some extra dough for a down payment on the boat they were eyeing, or even possibly a residency director who needed to increase the programs "numbers" in order to maintain accreditation. It truly was amazing to watch how these guys spoke to the patients and used their charm , wit, scientific knowledge, etc to "talk someone into" (or out of surgery if it was a poor surgical candidate or a drug seeking patient). I'm not going as far as saying these patients didn't benefit from the surgeries or that they were subjected to unnecessary procedures, it just simply was amazing at how certain people can "sell surgery" to a patient.

  • Quote:

    Dieter,

    I saw this in an email I got earlier today. I have not yet had time to read it but plan on doing so. When I saw this item I was reminded [as I apparently often am] of one class in podiatry school where the lecturer stated to us all that 'every surgeon is really a serial killer that has found a socially acceptable way to express their desire."

    I know that I sat there in disbelief, thinking 'well, here's 100 serial killers that you just insulted.' Or some thought to that effect. Over the years I've often wondered about this, and have seen occainsonal references regarding this concept. This is one book I expect to read.

    Dave Gottlieb, DPM

    views expressed are my own and no one elses

    Dave,

    I find this aspect of psychology fascinating.

    I today bought the Kindle version of the book for some light reading!

    ~Dieter

  • Dieter,

    I saw this in an email I got earlier today. I have not yet had time to read it but plan on doing so. When I saw this item I was reminded [as I apparently often am] of one class in podiatry school where the lecturer stated to us all that 'every surgeon is really a serial killer that has found a socially acceptable way to express their desire."

    I know that I sat there in disbelief, thinking 'well, here's 100 serial killers that you just insulted.' Or some thought to that effect. Over the years I've often wondered about this, and have seen occainsonal references regarding this concept. This is one book I expect to read.

    Dave Gottlieb, DPM

    views expressed are my own and no one elses