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Can doctor–patient differences have clinical implications?

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When it comes to traits that are highly valued by patients in a doctor, conscientiousness and empathy rank highly.
 
But how do character traits between doctors and their patients differ – and could there be implications for the doctor–patient relationship? Researchers from the University of Queensland and University of Melbourne certainly think so.
 
In an analysis, published in BMJ Open, researchers analysed the responses from two nationally representative Australian surveys where doctors and people from the general population were asked to assess their own personality traits.
 
The research compared two longitudinal datasets: responses of more than 19,000 doctors – including 5844 GPs – from the Medicine in Australia: Balancing Employment and Life (MABEL) survey and those of more than 23,000 Australians from the Household, Income and Labour Dynamics in Australia (HILDA) survey.
 
The questions focused on the following personality traits:

• conscientiousness
• agreeableness
• extroversion
• neuroticism
• openness
• locus of control – belief in personal agency rather than external forces such as fate, a higher power, or powerful others.

The findings suggest that doctors are more extroverted, agreeable, and conscientious than their patients.
 
However, they also apparently tend to be more neurotic, less open, and more likely to strongly believe themselves to be subject to external forces beyond their control.
 
The team also compared the traits of the different groups of doctors and found that while there were almost no statistically significant differences in personality, GPs were the exception and found to be more agreeable than all the other groups.
 
Meanwhile, female doctors were found to be overall more conscientious and extroverted, and also more neurotic and less open compared with their male counterparts.
 
Dr Marguerite Tracy, a GP, senior lecturer and member of RACGP Expert Committee – Quality Care, told newsGP she was surprised by the consistency of differences between doctors and the rest of the population.
 
‘I wondered about nature versus nurture,’ she said. ‘Are doctors generally different to the rest of the population because they managed to get into medical school – or because they have been through medical training?
 
‘There are many aspects of training which suit being conscientious, and even having a bit of neuroticism in order to complete undergraduate and post-graduate training.’
 
But when it comes to GPs being more agreeable than other doctors and the general population, Dr Tracy says she is less surprised.
 
‘All the GPs I know are highly agreeable,’ she said.
 
‘General practice means developing relationships with people, sometimes over a lifetime – you have to be agreeable to do that. We probably self-select into general practice for that reason.’
 
While that may be the case, the researchers say that the character trait differences found between doctors and patients could have clinical implications for the doctor–patient relationship and, ultimately, the success of treatment.
 
‘For example, being more conscientious has implications for treatment adherence as conscientious doctors may overestimate their patients’ ability to follow recommendations,’ the authors wrote.
 
‘Higher doctor neuroticism, which is related to stress, could lead doctors to see stress as a normal part of life, and, thus, underestimate the impact of [it] on patient wellbeing.’
 
They also note that while doctor agreeableness and conscientiousness ‘increase patient satisfaction with care’, these traits could potentially lead doctors to view patients – in contrast to themselves – ‘as more confrontational and less conscientious than patients actually are’.
 
‘[This could cause] an asymmetry in doctor and patient judgements of one another, which could impact outcomes,’ they authors wrote.
 
To avoid this, the researchers say doctors could take these differences into account to ‘better calibrate their judgments of patients’ and ‘gain insight into factors that influence their patient interactions’.
 
Dr Tracy does not disagree. But having explored factors affecting patient likelihood to participate in shared decision making as part of her PhD, she says there are many factors beyond personality to consider when it comes to improving patient care.
 
‘One of the systematic review papers cited in the article found no correlation between interpersonal behaviours and quality of care,’ Dr Tracy said.
 
‘I would say that it is good to recognise that there are more differences between medical professionals and the rest of the population than just how much we know.
 
‘However, we know that power imbalance, time factors and numerous other patient/doctor/environment factors affect the patient’s likelihood to participate in shared decision making or ask their doctor a question.’
 
Among the limitations of the analysis were that the scales used to assess personality traits were self-rated, and the ‘big 5’ descriptors differed slightly between the two surveys.
 
And while a lack of personality difference was noted between doctor specialties, the researchers did say that the differences found between doctors and those in other caring professions suggests that including non-doctor caring professionals in clinical teams ‘will increase personality diversity and, thus, team performance’.
 
Dr Tracy believes it should be taken one step further, to include non-health professionals in decisions about priorities of healthcare provision.
 
‘Healthcare consumers’ involvement in services and services acting on patient feedback can go a long way to improving the delivery of healthcare,’ she said.
 
‘And takes into account the way those outside services perceive us and the care we deliver.’
 
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character traits clinical implications communication doctor-patient relationships treatment outcomes

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