Are obstetricians and gynaecologists just sociopaths?

Someone recently asked me, in the wake of the birth trauma enquiry and a series of confronting newspaper headlines, “Are obstetricians and gynaecologist just sociopaths?”

I was surprised by how defensive I felt in that moment. Not because the question was malicious, but because it reflected a growing and deeply uncomfortable misunderstanding of what this specialty actually demands of the people who practise within it. The question wasn’t really about personality disorders. It was about how clinicians behave under pressure, how empathy is expressed in crisis and why some doctors can appear emotionally distant at precisely the moments when outcomes matter most.

Obstetrics and gynaecology is sometimes perceived as a specialty that rewards emotional distance. In moments of crisis, obstetricians in particular can appear abrupt, contained or overly decisive. From the outside, this can feel confronting, especially when viewed through the lens of adverse outcomes, inquiries or media scrutiny.

The short answer to that question is no. Obstetricians and gynaecologists do not, as a group, have sociopathic tendencies. But the longer answer matters, because misunderstanding the psychological demands of this work has real consequences for workforce wellbeing, complaints culture and how the specialty is supported by institutions and policy.

When clinicians are described as “cold” or “uncaring”, what is usually being observed is not an absence of empathy, but emotional containment. In high-risk medicine, empathy is not removed; it is regulated. The capacity to pause emotional response long enough to make a clear decision is not a moral failure. It is a learned clinical skill.

Obstetrics represents one of the most psychologically demanding areas of medicine. It involves time-critical decision-making, high litigation exposure and responsibility for two patients whose interests may not always align. In emergencies, there is often no opportunity for deliberation or consensus. Someone must decide, act and accept responsibility for outcomes that may be tragic regardless of intent or skill.

This produces a form of psychological adaptation best described as crisis leadership. Obstetricians learn to narrow attention, suppress emotional processing in the moment, and act decisively under uncertainty. Emotional responses are often delayed rather than absent, processed later, privately or sometimes incompletely. Over time, this can create an external style that appears emotionally restrained, particularly in acute settings.

High-risk obstetrics intensifies this further. Repeated exposure to perinatal loss, maternal morbidity, severe fetal anomaly and irreversible outcomes places clinicians at risk of moral injury. This is not burnout in the conventional sense, but the cumulative distress of doing the right thing and still living with harm. Emotional detachment in this context is usually protective, not pathological.

Gynaecology, by contrast, demands a different psychological profile. Benign gynaecology is less time-critical and more relational. Care is usually longitudinal, decision-making is collaborative and outcomes are rarely immediately life-threatening. This allows empathy to be expressed more openly.

Complex gynaecology, including endometriosis, pelvic pain, infertility and chronic bleeding, requires sustained emotional endurance. Many patients arrive after years of dismissal or trauma. Clinicians working in this space must tolerate ambiguity, partial improvement and ongoing distress. Lack of empathy is quickly exposed and poorly tolerated.

Across obstetrics and gynaecology, what is sometimes misinterpreted as sociopathy is far more accurately understood as emotional regulation under load. True sociopathic traits are incompatible with the trust-based, high-accountability environment of this specialty.

Recognising this distinction matters. When emotional containment is misread as emotional deficiency, clinicians are judged unfairly, complaints escalate and systems respond punitively rather than supportively. Obstetricians and gynaecologists practise different forms of empathy under different constraints. Understanding that complexity is essential if we want a sustainable, compassionate women’s health workforce.

Dr Elizabeth Jackson

NASOG President

References: 

Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Federal Practitioner. 2019;36(9):400–402.

LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Academic Medicine. 2009;84(10 Suppl):S25–S33.

Larson EB, Yao X. Clinical empathy as emotional labor in the patient–physician relationship. JAMA. 2005;293(9):1100–1106.

Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians. JAMA. 2005;293(21):2609–2617.

Shaw D, Elger B. Understanding professionalism: a sociological approach. Medical Education. 2010;44(2):148–155.