Victims and Predators in Medicine: Roles, Not Identities

In any medical encounter, two dynamics are always present: an asymmetry of power, and the constant risk of what that asymmetry can become. We rarely speak plainly about this. But if we want to understand why so many clinical relationships go wrong — not dramatically, not with malice, but quietly and structurally — we need to look honestly at the positions people slide into under pressure.

The words "victim" and "predator" carry heavy moral weight. Used carelessly, they assign permanent identities: the evil doctor, the helpless patient, the corrupt institution. That is not what these words mean here. A predatory position is one in which a person uses power, knowledge, or institutional backing in ways that disregard someone else's dignity. A victim position is one centered on helplessness — on being acted upon, on having no agency, on being owed rather than responsible. Both are positions people move through. Neither is a fixed character trait.

How the Slide Happens

The slide usually begins with something small. In medicine, asymmetry is structural. One person has clinical knowledge, institutional authority, access to resources. The other is exposed, dependent, uncertain. When the encounter is well-formed — clear, respectful, bounded — this gap can serve protection. When the form is poor, the same gap bends into something else.

From the side of greater power, the drift toward a predatory stance often starts with minor moves: using jargon to close off questions, invoking "policy" to avoid explanation, making decisions without acknowledgment of the person affected. From the side of less power, the drift toward a victim stance may begin with abandoning the effort to ask, exaggerating helplessness, or treating every limit as evidence of cruelty.

Both movements are understandable. Neither is harmless.

What Each Position Looks Like in Practice

A doctor in a predatory position uses the authority of the role to dominate rather than guide — implying "I know, you don't," or using the threat of withdrawal as leverage rather than as a carefully considered last resort. A doctor in a victim position presents themselves as entirely without agency: "There's nothing I can do; it's all the system." The complaint is sometimes true and sometimes a way of evading responsibility for what can, in fact, be changed.

A patient in a predatory position uses dependence as a weapon — threatening complaints not as a call to accountability but as a means of control. A patient in a victim position surrenders responsibility entirely, expecting to be fixed without participation, reading every "no" as abandonment.

A leader in a predatory position governs through fear: fear of punishment, of shame, of job loss. A leader in a victim position presents themselves as powerless between administrators above and resistant staff below — and thereby avoids acting on the structures they actually have authority to reshape.

Why This Logic Is So Costly

The victim–predator dynamic does not just create unpleasant encounters. It distorts the work itself. Information becomes unsafe to share. Curiosity collapses — no one is genuinely interested in understanding; everyone is defending or attacking. Errors become ammunition rather than data. Learning stops. Clinicians burn out. Patients come later and sicker. Trust erodes from every direction at once.

Most critically, this logic occupies all available space. When it takes hold of an encounter, almost no other form can exist alongside it. Every expression of need reads as manipulation. Every boundary reads as aggression. Every attempt at honest communication becomes a move in a struggle neither party chose and neither party can easily exit.

A Different Possibility

These are not stable identities. The same person can hold a predatory position in one relationship and a victim position in another — sometimes within the same afternoon. This is exactly why fixing our attention on "good people" and "bad people" misses the point entirely. The positions shift too fast for that analysis to help anyone.

What can help is recognizing the pattern early enough to interrupt it: noticing when an encounter has stopped being about the problem and has become about the struggle, feeling the pull of the familiar script, and choosing — deliberately, with some effort — a different way of standing in the room.

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Mykola Iabluchanskyi Yabluchansky