History is written in real time. But with figures such as Donald Trump and Elon Musk casting themselves as main characters in some dystopian blockbuster, it feels more surreal than ever. Their self-crafted starring roles highlight a truth about history: it’s often shaped not just by people in power but by those who step into the spotlight and claim it. This often involves what some people call “main character syndrome.”

The idea of seeing yourself as the protagonist in every scene may be a concept plucked from social media, but it’s one with profound implications for healthcare. Medicine can feel like a stage: a world where life, death, and recovery collide in real time. Doctors, nurses, and clinicians play key roles in this ongoing drama. Some view themselves as saviours, the indispensable heroes in every crisis. And, at first glance, this might seem admirable. Isn’t medicine built on confidence and impactful action?

There are upsides to being the main character. It can foster the resilience to spend many hours tackling monumental tasks, whether that’s navigating a pandemic or, for me, completing Elden Ring. It’s the confidence that says, “I’ll take the scalpel” or “I’ll lead this resuscitation,” when everyone else hesitates. There are moments in medicine when you must be that main character and shoulder the responsibility, knowing that a patient’s life depends on it.

But there are also real dangers. A hero complex blinds us to the quiet brilliance of others: the nurse who notices a subtle change in a patient’s breathing or the lab technician who flags a critical result. Like an Elden Ring player ignoring the countless NPCs (non-player characters) who enrich that world, the self-absorbed clinician risks missing the collective effort that saves lives. Arrogance, born from this syndrome, may leave no room for humility or learning.

Such beliefs can also lend an excuse for unprofessional behaviour. In their excellent review on bad behaviour in healthcare,1 Liz Crowe and Christine Riley describe how people with a main character complex “consume considerable resources and energy, commonly with no observable consequences.” They argue that repeat perpetrators of unprofessional behaviour are often confident and intelligent with strong social skills, often possessing a unique skill set important to their organisation. In other words, it’s the perfect excuse to see yourself as the main character. Contrast these with the so called NPCs in medicine: those who quietly follow protocols, avoid the spotlight, and never imagine themselves at the centre of any narrative.

In truth, the best clinicians are those who understand when to be the main character and when to be an NPC. Sometimes what matters is your ability to be average or to display excellent “followership.”23 Like a skilled player in an open world video game, you must learn when to lead, when to collaborate, and when to let someone else take centre stage.

In the end, the true protagonist is always the patient. Our job isn’t to dominate their story but to help them navigate it. We’re never the main characters, even if we think we are.