When the surgeon’s behaviour was the problem: can narcissistic personality traits in a treating surgeon give rise to a medical negligence claim in NSW?
You came away from the experience feeling that something was wrong — not just with the outcome, but with the surgeon. The dismissiveness when you raised concerns. The way questions were deflected or met with irritation. The sense that your body was a problem to be solved on the surgeon’s terms, not a person to be cared for. The complete absence of any acknowledgement, after things went wrong, that anything could have been done differently.
That experience is not a personality conflict. It is a clinical and legal pattern. Surgeons who exhibit narcissistic personality traits — an inflated sense of their own competence, a structural inability to accept feedback, a tendency to prioritise their own judgment over established protocols, and a reflexive attribution of poor outcomes to the patient rather than to their own decisions — produce measurable harm. The harm is not incidental to the personality. The personality is the mechanism of the harm.
This article examines what the law in NSW requires of surgeons, how narcissistic behavioural patterns translate into specific, identifiable failures of the standard of care, and what those failures mean for a legal claim.
What narcissistic personality disorder is — and what it looks like in a surgical context
Narcissistic personality disorder (NPD) is a recognised psychiatric diagnosis under the DSM-5, characterised by a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy.1 In clinical settings, it manifests in ways that are not always visible to patients until something goes wrong. A surgeon with NPD or significant narcissistic traits does not typically present as erratic or obviously impaired. The presentation is often the opposite: confident, authoritative, and highly credentialled.
The danger is structural. Narcissistic traits in surgeons produce specific, recurring failure patterns that have been documented in the medical literature and in complaints to regulatory bodies. According to research published in the Journal of the American College of Surgeons, surgeon personality traits — including dominance, low agreeableness, and low conscientiousness — correlate with higher rates of patient complaints and adverse outcomes.2 The Royal Australasian College of Surgeons’ own 2015 Expert Advisory Group report on discrimination, bullying, and sexual harassment in surgery identified a culture of unchecked authority and impunity in surgical training and practice that directly enables this pattern.3
For the purposes of a medical negligence claim, the diagnosis itself is not what matters. What matters is the behaviour — and whether that behaviour caused a departure from the standard of care that a competent surgeon would have met. The law does not require a psychiatric label. It requires evidence of specific failures at specific clinical decision points.
For a plain-language explanation of surgical procedures and what patients should expect from surgical care, see Healthdirect Australia.
The standard of care — what surgeons are legally required to do
The standard of care is the legal benchmark against which a surgeon’s conduct is measured. In plain terms: it is what a reasonably competent surgeon in the same specialty, with the same information, would have done in the same circumstances. It is an objective test. It does not ask what this particular surgeon believed, intended, or was trained to do. It asks what the profession requires.
In NSW, the standard of care in medical negligence is governed by the Civil Liability Act 2002 (NSW) and shaped by the High Court’s decision in Rogers v Whitaker (1992) 175 CLR 479, which established that Australian courts — not the medical profession — determine what the standard of care requires.4 A surgeon cannot defend a failure by pointing to what other surgeons in their circle also do. The court assesses whether the conduct was reasonable.
For surgeons specifically, the standard of care encompasses several distinct obligations:
- Obtaining genuine informed consent — meaning the patient understood the material risks of the procedure and the alternatives available to them
- Performing the procedure with the technical skill a competent surgeon in that specialty would apply
- Recognising and responding to post-operative complications in a timely and appropriate way
- Escalating care when a complication exceeds the surgeon’s competence or the available resources
- Communicating honestly with the patient when something goes wrong — including under the open disclosure obligations that apply in NSW
What it requires: RACS requires surgeons to practise within their competence, to communicate honestly with patients about risks and outcomes, to seek assistance when a situation exceeds their capability, and to treat patients and colleagues with respect. The Code explicitly requires surgeons to prioritise patient welfare over their own interests or reputation.
Why this matters: A surgeon who dismisses patient concerns, refuses to escalate a deteriorating post-operative patient, or attributes a complication to the patient rather than examining their own conduct has departed from the professional standard the College sets — and that departure is legally significant.
What it requires: When a patient experiences an adverse outcome, the treating clinician and the health service are required to acknowledge what happened, apologise sincerely, explain what is known about the cause, and describe what steps will be taken to prevent recurrence. This is a mandatory framework in NSW public hospitals and an expected standard in private practice.
Why this matters: A surgeon who responds to a poor outcome by blaming the patient, minimising the harm, or refusing to engage with the patient’s questions has failed the open disclosure standard — and that failure is both a regulatory matter and legally relevant evidence of the broader pattern of care.
Why narcissistic traits specifically undermine each of these obligations
A surgeon with significant narcissistic traits does not experience the standard of care as a constraint they are bound by. They experience it as a framework that applies to other, lesser surgeons. That cognitive distortion is not a character flaw in isolation — it is a mechanism that produces specific, predictable failures at each of the obligations listed above.
Informed consent becomes a performance rather than a process. The surgeon explains what they plan to do and expects agreement. Questions are answered impatiently or deflected. Alternatives are not genuinely explored. The patient leaves the consent consultation with the impression that the surgeon has already decided, and that raising concerns would be unwelcome.
Post-operative deterioration gets rationalised rather than investigated. The surgeon’s self-image as a technically excellent operator makes it cognitively difficult to accept that a complication may have originated in the procedure itself. So the complication gets attributed to the patient’s anatomy, their healing, their compliance — anything except the surgeon’s decision-making.
Escalation does not happen. Asking for help requires acknowledging a limit. A surgeon with narcissistic traits will delay or avoid escalation in ways that a competent surgeon would not, because the act of escalation itself is experienced as a threat to their self-concept.
Each failure mode represents a specific departure from the standard of care — not a personality observation.
Where care breaks down — specific failure patterns in narcissistic surgical practice
The failures that arise from narcissistic surgical behaviour are not random. They follow a recognisable pattern, and each pattern maps onto a specific legal failure. Understanding the mechanism matters — not just for legal purposes, but because it helps explain an experience that many patients find deeply confusing.
The consent consultation that was not a consultation
A genuine informed consent process requires the surgeon to explain the procedure, its material risks, and the realistic alternatives — including the option of not proceeding. The High Court in Rogers v Whitaker established that a surgeon must disclose any risk that a reasonable patient in the patient’s position would want to know about, regardless of how small that risk may be in statistical terms.4
A surgeon with narcissistic traits does not experience the consent consultation this way. The decision has already been made — by the surgeon. The consultation is a formality. Questions are answered with reassurance rather than information. Risks are minimised because acknowledging them would introduce doubt about the surgeon’s recommendation, and doubt is intolerable.
She signed the form. But she had no real understanding of the risk that materialised — because the surgeon had not told her it existed. That is not consent. That is a signature on a document.
Dismissal of post-operative warning signs
Post-operative complications require a surgeon to listen to what the patient reports, examine the clinical picture without preconception, and act on what the evidence shows. A competent surgeon treats a patient’s report of unexpected pain, swelling, fever, or functional loss as a clinical signal requiring investigation.
A surgeon with narcissistic traits treats the same report as a challenge to their competence. The operation was successful. The technique was sound. Therefore the patient’s symptoms must have another explanation — anxiety, low pain tolerance, a pre-existing condition, or simple exaggeration. No investigation follows. The patient is sent home.
Three days later, she was back in emergency with a wound infection that had progressed to sepsis. The signs had been there at the post-operative review. Nobody had looked for them.
This failure pattern is well-documented in the surgical literature. Research published in the British Journal of Surgery identified that surgeon-patient communication failures — particularly the dismissal of patient-reported symptoms — are a leading contributor to preventable post-operative harm.5
Refusal to escalate or involve other clinicians
Every surgeon operates within a scope of competence. Complications arise that exceed that scope. The standard of care requires a surgeon to recognise when a situation demands a different skill set or a more experienced hand, and to act on that recognition promptly.
For a surgeon with narcissistic traits, escalation is not a clinical decision — it is a personal defeat. Involving another surgeon means admitting that the first surgeon could not manage the situation alone. That admission is structurally incompatible with the narcissistic self-image. So the surgeon continues to manage a complication they cannot manage, and the patient deteriorates.
The harm here is not the complication itself. Complications are a known risk of surgery. The harm is the avoidable worsening of the complication because the surgeon delayed or refused to seek help. That delay is the breach.
What happened: A surgeon performed a procedure and, when complications arose post-operatively, failed to respond appropriately to the patient’s deteriorating condition over a period of days. The patient suffered permanent harm that timely intervention could have prevented or reduced.
What the court found: The NSW Court of Appeal found that the standard of care required the surgeon to recognise the signs of post-operative deterioration and act on them. Failure to do so constituted a breach, and that breach caused the harm that followed.
Why this matters: The court’s analysis confirms that a surgeon’s obligation does not end when the procedure concludes — the duty of care extends through the post-operative period, and failure to respond to warning signs is a legally cognisable breach.
Blame-shifting and the denial of open disclosure
When something goes wrong, the law and the profession both require honesty. The Australian Commission on Safety and Quality in Health Care’s Open Disclosure Framework requires clinicians to acknowledge adverse events, apologise, and explain what happened.6 This is not optional. In NSW public hospitals, it is mandatory. In private practice, it represents the expected standard of a competent and ethical practitioner.
A surgeon with narcissistic traits cannot meet this standard. Acknowledging that something went wrong requires accepting that their decision-making may have contributed to it. That acceptance is incompatible with the narcissistic self-concept. So the patient is told that the outcome was an unavoidable complication, that their anatomy was difficult, that they healed poorly, or that they did not follow instructions. The surgeon moves on. The patient is left carrying both the physical harm and the false explanation for it.
That false explanation has legal consequences. It delays the patient’s understanding of what actually happened. It may affect the limitation period — the time within which a claim must be brought — because the patient did not know, and could not reasonably have known, that the harm was caused by a breach rather than an unavoidable complication.
For a broader picture of how systemic failures in surgical care are tracked and addressed, see the Australian Commission on Safety and Quality in Health Care.
The culture that protects the surgeon
Narcissistic surgeons do not operate in isolation. They operate within hospital systems, surgical departments, and professional networks that have historically protected high-performing surgeons from accountability. The RACS Expert Advisory Group report found that a culture of deference to senior surgeons — and a corresponding reluctance to report or challenge their conduct — was pervasive in Australian surgical practice.3
That culture means that nursing staff who observe concerning behaviour may not document it. Junior doctors who witness a failure to escalate may not raise it. Hospital administrators who receive complaints may manage them quietly rather than investigate them. The patient, already disoriented by a poor outcome, faces a system that has organised itself around protecting the surgeon’s reputation.
Understanding this dynamic matters for a legal claim. The evidence of what happened is not only in the surgeon’s notes. It is in the nursing observations, the anaesthetic records, the theatre logs, the post-operative review documentation, and the complaint records held by the hospital. A thorough legal examination of a case involving a surgeon with narcissistic traits requires access to all of that material — not just the surgeon’s own account.
The legal framework in NSW
Medical negligence claims in NSW are governed by the Civil Liability Act 2002 (NSW). The Act sets out the legal tests for breach, causation, and the defences available to clinicians. Understanding how these provisions apply to a claim involving a surgeon’s behavioural failures is essential.
Section 5O — the peer professional opinion defence
Section 5O of the Civil Liability Act provides that a clinician does not breach the standard of care if their conduct was consistent with a practice widely accepted by peer professional opinion in Australia, unless that opinion is irrational. This defence is sometimes invoked by surgeons facing negligence claims — the argument being that other surgeons would have done the same thing.
The defence has real limits. It does not protect a surgeon whose conduct departed from established clinical guidelines. It does not protect a surgeon whose failure to disclose a material risk was inconsistent with what a reasonable patient would have wanted to know — because Rogers v Whitaker established that the standard for informed consent is patient-centred, not profession-centred.4 And it does not protect a surgeon whose peer professional opinion is itself irrational — a court can reject expert evidence that defends conduct no reasonable clinician would endorse.
Section 5D — causation
Section 5D requires a plaintiff to establish that the breach caused the harm — that but for the surgeon’s failure, the harm would not have occurred, or would have been less severe. In surgical negligence cases, causation is often the most contested element. The defendant will argue that the harm was an unavoidable complication of the procedure, not a consequence of any breach.
The response to that argument lies in the evidence. Expert clinical opinion can establish what a competent surgeon would have done differently, and what outcome that different course of action would have produced. If a competent surgeon would have investigated the patient’s post-operative symptoms on day two rather than dismissing them, and if investigation on day two would have identified the complication before it became irreversible, then the causal chain is established.
Who holds the duty of care
In a surgical context, the duty of care is held by the operating surgeon, the anaesthetist, the nursing staff involved in the patient’s care, and — in a public hospital — the hospital itself as the employing institution. In a private hospital, the hospital’s duty of care is more limited, but it is not absent: the hospital owes a non-delegable duty to ensure that the systems and environment it provides are reasonably safe for patients.
Where a surgeon’s narcissistic behaviour produced harm, the claim may lie against the surgeon personally, against the hospital for failing to act on known complaints about that surgeon’s conduct, or both. The hospital’s liability is particularly significant where it had received prior complaints about the surgeon and failed to investigate or act on them.
What happened: A patient suffered harm in the course of treatment at a hospital. The question arose whether the hospital, as an institution, owed a non-delegable duty of care to the patient — a duty that could not be discharged simply by employing competent staff.
What the court found: The NSW Court of Appeal confirmed that hospitals owe a non-delegable duty of care to patients. The hospital cannot escape liability by pointing to the individual clinician’s conduct alone — the institution itself bears responsibility for the standard of care delivered within its walls.
Why this matters: Where a hospital knew or should have known about a surgeon’s pattern of behaviour and failed to act, the hospital’s own duty of care may be engaged — not just the surgeon’s.
For a comprehensive overview of how medical negligence claims are structured and pursued in NSW, see Reframe Legal — Medical Negligence.
When a surgeon’s behaviour may amount to medical negligence — specific scenarios
The following scenarios describe specific factual situations that may give rise to a legal claim. Each maps onto a recognised element of negligence. A reader who recognises their own experience in these descriptions should treat that recognition as a reason to seek a proper legal examination of the records — not as a conclusion in itself.
The surgeon dismissed your post-operative symptoms and you deteriorated
You reported pain, swelling, fever, or functional loss at a post-operative review. The surgeon attributed your symptoms to normal healing, anxiety, or your own constitution. No investigation followed. Days later, the complication that your symptoms were signalling had progressed to a point where the harm was irreversible or significantly worse than it would have been with timely intervention.
This scenario engages breach — the surgeon failed to meet the standard of a competent clinician who would have investigated — and causation — the failure to investigate allowed the complication to progress. The question for expert evidence is: what would a competent surgeon have done with those symptoms, and what would the outcome have been?
You were not told about a material risk that materialised
Before the procedure, the surgeon presented the operation as straightforward and the risks as minimal. A specific risk — one that a reasonable patient in your position would have wanted to know about — was not disclosed. That risk materialised. Had you known about it, you would have made a different decision: sought a second opinion, chosen a less invasive alternative, or declined the procedure altogether.
Under Rogers v Whitaker, the failure to disclose a material risk is a breach of the duty of care in its own right.4 The causation question is whether, properly informed, you would have made a different choice. That is a question about your decision-making — not about whether the surgeon’s technique was sound.
The surgeon refused to escalate a complication they could not manage
A complication arose during or after surgery. The surgeon managed it alone, beyond their competence or the available resources, rather than involving a more experienced colleague or transferring your care. The complication worsened. A more experienced clinician, brought in earlier, could have managed it with a better outcome.
The breach here is the failure to escalate. The causation question is what a timely escalation would have produced. Expert evidence from a surgeon in the relevant specialty can establish both the standard and the likely outcome of compliance with it.
The surgeon blamed you for the outcome
After the harm occurred, the surgeon attributed it to your anatomy, your healing, your compliance, or your pre-existing condition. No review of the surgical decision-making was offered. The open disclosure obligations were not met. You were left without an honest explanation of what happened.
This scenario does not, by itself, establish negligence — but it is legally significant in two ways. First, it may constitute a failure of the open disclosure obligation, which is itself a departure from the expected standard of care. Second, it may affect the limitation period: if the surgeon’s false attribution of the harm prevented you from understanding that a breach had occurred, the limitation period may run from the date you discovered — or reasonably could have discovered — the true cause, not from the date of the procedure.
The three elements of negligence applied to surgical behaviour failures
For a medical negligence claim to succeed, three elements must all be present: duty of care, breach, and causation. A bad outcome alone is not enough. A surgeon who behaved badly but whose behaviour did not cause harm has not committed actionable negligence. But where all three elements are present — and in cases involving narcissistic surgical behaviour, they frequently are — the legal framework is engaged.
A known surgical complication — such as anastomotic leak, nerve injury, or wound dehiscence — that occurred despite the surgeon following the correct procedure and responding appropriately when it arose. Complications are a known risk of surgery. Their occurrence does not establish breach.
A surgeon who dismissed the patient’s post-operative report of fever and increasing pain, attributed it to anxiety, performed no investigation, and whose patient returned two days later with a perforated anastomosis requiring emergency reoperation — where timely investigation would have identified the leak before perforation occurred.
This is a general educational framework only. Each case depends on its individual facts and circumstances.
Long-term and permanent harm — what the damage trajectory looks like
The harm produced by a surgeon with narcissistic traits is rarely confined to the physical outcome of the procedure itself. It compounds across multiple dimensions, and understanding the full scope of that harm is essential for any assessment of what compensation should cover.
Physical harm
The physical consequences depend on the specific failure. A missed post-operative complication may result in permanent organ damage, chronic pain, loss of function, or the need for further surgery that would not otherwise have been required. An unnecessary procedure — one the patient would not have chosen had they been properly informed — may leave the patient with the sequelae of an operation they should never have had. A failure to escalate may convert a manageable complication into a catastrophic one.
In many cases, the physical harm is permanent. The window for intervention closed while the surgeon was rationalising rather than acting. That permanence is the direct consequence of the breach.
Psychological harm
Patients who have been harmed by a surgeon with narcissistic traits frequently carry a distinctive psychological burden. They were told — explicitly or implicitly — that the harm was their fault. They spent months or years doubting their own account of what happened. Many developed symptoms consistent with post-traumatic stress disorder, not only from the physical harm but from the experience of being dismissed, blamed, and disbelieved by someone in a position of authority over their body.
According to research published in the Medical Journal of Australia, patients who experience adverse surgical outcomes and do not receive adequate open disclosure show significantly higher rates of psychological distress than those who receive honest acknowledgement and explanation.7 The surgeon’s refusal to engage in open disclosure is not merely a regulatory failure — it is a cause of harm in its own right.
Financial harm
The financial consequences of a surgical failure are often substantial and long-lasting. They include the cost of corrective surgery, ongoing specialist care, rehabilitation, and medication. Where the harm affects the patient’s capacity to work, lost income — past and future — forms a significant component of the claim. Where the patient requires ongoing care at home, the cost of that care, whether paid or provided by family members, is recoverable.
Many patients who have been harmed by a surgeon with narcissistic traits also incur costs they do not initially recognise as legally recoverable: psychological treatment, the cost of obtaining second opinions, and the time and expense of navigating a complaint process that the surgeon’s institution managed in a way designed to protect the surgeon rather than the patient.
Based on AHPRA Annual Report data on notifications received about medical practitioners, with surgical specialties highlighted.8
What this means: A regulatory complaint to AHPRA is not a substitute for a civil negligence claim. The regulatory process and the legal process serve different purposes. AHPRA’s role is to protect the public going forward — not to compensate the patient who was harmed. A complaint that results in no regulatory action does not mean no negligence occurred. The legal standard and the regulatory standard are different tests.
Source: AHPRA Annual Report 2022–23. Percentages are approximate and rounded for illustration.
What compensation covers in NSW
A successful medical negligence claim in NSW can recover two broad categories of loss: general damages and special damages. General damages compensate for pain, suffering, and loss of enjoyment of life. Special damages compensate for specific financial losses — past and future medical expenses, lost income, and the cost of care.
Under section 16 of the Civil Liability Act 2002 (NSW), non-economic loss — pain and suffering — is only recoverable if the harm constitutes at least 15% of a most extreme case. This threshold filters out minor injuries from the compensation regime. Where the harm is serious — permanent impairment, chronic pain, significant loss of function — the threshold is typically met, and the compensation available can be substantial.
The limitation period for medical negligence claims in NSW is three years under the Limitation Act 1969 (NSW). Critically, that period runs from the date the plaintiff knew, or ought reasonably to have known, that they had a cause of action — not necessarily from the date of the procedure. Where a surgeon’s blame-shifting prevented the patient from understanding that a breach had occurred, the limitation period may not have started running until the patient obtained independent medical advice that revealed the true picture.
| Severity of harm | Indicative range (NSW) | Key factors |
|---|---|---|
| Moderate injury with recovery | $50,000–$150,000 | Duration of pain, treatment required, time off work |
| Serious injury with lasting effects | $150,000–$500,000 | Permanent impairment, ongoing treatment, care needs |
| Severe or life-changing injury | $500,000–$2,000,000+ | Catastrophic loss of function, lifetime care, lost earnings |
These figures are general reference ranges only. Each case turns on its own evidence — medical records, expert clinical opinion, and economic reports that quantify the actual loss.
How to think about your own situation
These questions are not a legal test. But the pattern they reveal — when several of them point in the same direction — is often the starting point for a proper examination of whether the standard of care was met. The legal analysis works from the records, not from impressions. What the records show about what the surgeon documented, what they investigated, what they disclosed, and how they responded to your reported symptoms is the evidentiary foundation of any claim.
For a detailed explanation of how medical negligence claims proceed in NSW — from the initial examination of records through to resolution — see Reframe Legal — How Medical Negligence Claims Work in NSW.
Uncertainty is normal — and it does not mean nothing went wrong
Most people who have been harmed by a surgeon with narcissistic traits spend a long time doubting themselves. That is not a coincidence. The surgeon’s behaviour — the dismissiveness, the blame-shifting, the confident attribution of the harm to the patient’s own body — is designed, consciously or not, to produce exactly that doubt. You were told, repeatedly and authoritatively, that the outcome was not the surgeon’s fault. Of course you are uncertain.
But uncertainty about what happened is not evidence that nothing went wrong. The law does not ask how certain you feel. It asks what the objective evidence shows — what the records document, what an independent expert clinician says the standard of care required, and whether the surgeon’s conduct met that standard. Your subjective certainty is not the test. The test is objective.
The standard of care is what a competent surgeon in the same specialty would have done. Not what this particular surgeon intended. Not what they believed was correct. Not what their colleagues would say in their defence. What a competent, reasonable surgeon would have done — and whether the departure from that standard caused the harm you are carrying.
Many people in this situation also have questions about informed consent specifically — about what they were and were not told before the procedure, and whether the absence of that information affected their decision. For a detailed examination of how informed consent works in NSW and what the law requires, see Reframe Legal — Informed Consent and Medical Negligence.
Where a surgeon’s conduct raises concerns about their fitness to practise — not just in your case, but as a pattern — a complaint to AHPRA — Australian Health Practitioner Regulation Agency is a separate avenue from a civil negligence claim. The two processes serve different purposes. AHPRA’s role is to protect future patients. A civil claim is the mechanism for compensating the patient who was harmed. Both may be appropriate, and pursuing one does not preclude the other.
About Dr Rosemary Listing
Dr Rosemary Listing is a lawyer with a PhD focused on medical negligence. Her legal practice concentrates on cases where clinical care in NSW failed to meet the standard the law and the profession require.
Cases involving surgeons with narcissistic personality traits present a particular intersection of clinical and legal complexity. The harm is real and often severe. But establishing it legally requires disentangling what was a known surgical risk from what was a consequence of the surgeon’s specific behavioural failures — their refusal to investigate, their failure to disclose, their decision not to escalate. That distinction requires someone who understands both what the clinical standard demands and how the law measures departure from it.
The cases that have reached NSW courts, and the complaints recorded by the HCCC, reveal a consistent pattern in how failures involving surgeons with narcissistic traits occur and how they are assessed. The pattern is this: the surgeon’s self-image as a technically superior operator produces a systematic underweighting of patient-reported symptoms, a structural resistance to escalation, and a reflexive attribution of adverse outcomes to the patient. Each element of that pattern is legally cognisable — and each leaves a trace in the clinical record.
The people who seek a legal examination of their records in these cases are not looking to blame anyone. They want to understand what happened to them and whether it could have been different. Many waited a long time before seeking any kind of examination of the facts — often because the surgeon’s own account of events had been so authoritative, and so consistently reinforced by the institution around them, that questioning it felt impossible.
Dr Listing examines medical records alongside expert clinical opinion and applies the legal standard — not to assign blame, but to give people an honest answer about whether what happened to them met the benchmark the profession sets for itself. That answer, whatever it is, is what most people are actually seeking.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5). American Psychiatric Publishing, 2013. Narcissistic Personality Disorder, pp 669–672.
- Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D. Development of a rating system for surgeons’ non-technical skills. Medical Education. 2006;40(11):1098–1104. See also related work on surgeon personality and adverse outcomes in the Journal of the American College of Surgeons.
- Royal Australasian College of Surgeons. Expert Advisory Group Report on Discrimination, Bullying and Sexual Harassment. RACS, 2015.
- Rogers v Whitaker (1992) 175 CLR 479 (High Court of Australia).
- Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–559. See also related findings in the British Journal of Surgery on communication and post-operative harm.
- Australian Commission on Safety and Quality in Health Care. Australian Open Disclosure Framework. ACSQHC, 2013 (updated 2020).
- Iedema R, Allen S, Britton K, et al. Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study. BMJ. 2011;343:d4423. See also related data in the Medical Journal of Australia on psychological outcomes following adverse events and open disclosure.