Communication Style and Personality

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Patient traits: Pandora’s box in your room

Navigating through your patients’ personality packages towards proper communication

Linking Patient Personality and Communication Styles

Patient-centred medicine can be described as getting into the patient’s world and seeing disease through their eyes[1]. For the clinician, this requires empathy, adopting the patient’s perspective, addressing emotional aspects and building a relationship and partnership with the patient [2]. We can conclude that the better we understand our patient’s needs, the better we will be equipped to help optimise their health. Good communication  is a skill that can be learned, but we should be careful not to apply a set of communication techniques as a genetic one-size-fits-all model of gaining and providing information[2]. Every individual has a unique communication style, in much the same way that everyone has a unique personality.  Communication style can be defined as ”the characteristic way a person sends verbal, paraverbal, and nonverbal signals in social interactions denoting (a) who he or she is or wants to (appear to) be, (b) how he or she tends to relate to people with whom he or she interacts, and (c) in what way his or her messages should usually be interpreted”[3]. A number of tools objectively measure and categorize different communication styles[3].

Communication style can be considered an expression of personality[3]. Personality is defined as the psychological classification of any person, involving a pattern of thought, behaviour and emotion [4]. Personality is mostly genotypical but can also be altered by learning and environmental factors[3]. The correlation between different personality types and preference of communication styles has been a topic of much study and discussion [5][3][6].  Epidemiological links have been established between specific communication styles and personality; however, it is integral to remember that these links are merely probabilities and not definite indicators.  The conceptualisation of both personality and communication style is a particularly challenging task because of the complexity of the human psyche[6]

Much has been documented about communication styles of clinicians and how it affects patient-clinician communication. However, limited literature is available that describe the importance of understanding a patient’s preferred communication style for optimisation of patient-clinician communication. Understanding your patient’s communication style enables you to adapt your verbal and non-verbal behaviour to optimise transmission of information between both parties, which will lead to more positive outcomes. This concept is called physician behavioural adaptability.[7] Good interpersonal accuracy (that is, the ability to correctly assess characteristics and mental states of others on the grounds of their appearance an behaviours) plays an integral role in physician behavioural adaptability[2].

In this article, we will list the six domains of personality according to the HEXACO Personality Inventory (HEXACO-PI), and pair each one with its most closely correlated communication styles according to the Communication Style Inventory (CSI). More detail will be provided of both the personality domain and communication style in each section. Hereafter, we will attempt to demonstrate these typical traits in practice by creating different possibilities of patient scenarios. It is very important to note that personality and any linked personal traits are highly individualistic, and cannot be strictly categorised according to any specific model [6]. Also, although certain personalities have higher correlations towards certain communication styles, the majority of people’s psychological make-up comprises of combinations of personality domains and communication styles. The purpose of this article is thus not to create any prototypes, but to rather examine tendencies and trends to better understand why patients may be communicating and reasoning in the way they do. Also, we aim to equip ourselves to successfully transmit and receive information in the most understandable way for both ourselves and our patients.

HEXACO Personality Inventory

Results of HEXACO Personality Inventory of an individual (Wikipedia)

The HEXACO Personality Inventory (HEXACO-PI) is a model that proposes six replicable cross-culture dimensions of personality. This model has shown high internal consistency reliability and satisfactory convergent validities with external validities [8] and is a self-reported or observer-reported inventory performed by means of a questionnaire (https://hexaco.org/questionnaire). The test scores are provided on a scale of 1 to 5, where 1 is low and 5 is high. HEXACO is an acronym of the six dimensions it presents, namely Honestly-Humility, Emotionality, Extraversion (using the X in the acronym), Agreeableness, Conscientiousness and Openness to experience. Each of these dimensions are described by four facet-level scales. A score is given for each of these dimensions and the score-taker interprets the results as an overall combination.  An example of results is illustrated in Figure 1.

The Communication Style Inventory

The Communication Style Inventory (CSI) is a model of communication styles which proposes six domains of communication styles, namely Expressiveness, Preciseness, Verbal aggression, Questioningness, Emotionality and Impression manipulativeness [3]. Much like the HEXACO-PI, these six domains each have four subsets by which they are graded on a scale from 1 to 5. The CSI was the result of extensive research with its origin in lexicon studies – all possible adverbs and adjectives referring to communication were sourced and grouped [9] and these were refined into the six dimensions as concluded in the current inventory.

Correlations between HEXACO-PI and CSI

Table 1 provides a summary of the strongest correlations between personality domains and communication styles according to the HEXACO-PI and CSI.

HEXACO-PI DOMAIN CSI FACTOR: MAIN CORRELATION
Honesty-Humility Impression Manipulativeness[3]
Emotionality Emotionality[3]
Expressiveness Extraversion[3]
Agreeableness Verbal Aggressiveness (negative)[3]
Conscientiousness Preciseness[3][10]
Openness to experience Questioningness[3]

Personalities, communication styles and patients: Practical application

The correlated personality domains and communication styles will hence be discussed in more detail and at the hand of patient scenarios. Keep in mind that these scenarios all illustrate people at the extreme ends of the various domains, and that patients usually have more diversity in the combinations of personality traits and communication preferences. After each scenario, some recommendations and tips will follow on how to negotiate with specific traits and characteristics.

You will note that the patient profiles below are truly diverse. For each of these scenarios, take some time to reflect on the following questions:

●      What is the best way to receive the best quality of information from this individual?

●      In what way can I transmit information in the most efficient way to this individual?

●      What part of communication is probably easier with this individual?

●      What part of communication is probably particularly difficult with this individual?

Honesty-Humility and Impression Manipulativeness

“The Salt of the Earth vs the fraudster”

High scorers are honest, sincere, modest and are not driven by personal gain. Low scorers are deceptive, pretentious and may probably be untruthful for their own gain.

PERSONALITY  (HEXACO-PI) COMMUNICATION STYLE (CSI)
DOMAIN Honesty-humility Impression manipulativeness
SCORED ACCORDING TO THE FOLLOWING SUBSETS:
  1. Sincerity
  2. Fairness
  3. Greed Avoidance
  4. Modesty
  1. Ingratiation
  2. Charm
  3. Inscrutableness
  4. Concealingness
TELL-TALE SIGNS OF HIGH SCORERS ●      Sincere

●      Cooperative

●      Unassuming

●      Fair

●      Modest

●      Not driven by wealth

●      Genuine

●      Candid,

●      Truthful

●      Modest

TELL-TALE SIGNS OF LOW SCORERS ●      Sly

●      False/pretentious

●      Entitled

●      Greedy

●      Flattering

●      Will break rules for personal gain

●      Strong self-importance

●      Deceptive

●      False

●      Obscure

●      Ambiguous

●      Inscrutable

MORE INTERESTING FACTS ●People high on Honesty-Humility domain have a social vocational interest [11]

●Low score Honesty-Humility are correlated to the Dark Triad traits of Machiavellianism, Narcissism and Psychopathy[8]

The Salt of the Earth

Your patient, Dr McCarthy, works at a local hospice, helping those who cannot afford private medical care. Everyone knows her by her first name. On assessment, she answers your questions thoroughly and to the point, disclosing everything without thinking twice. You feel at ease with her, what you see is what you get. In the assessment, she mentions that she enjoys rowing as a sport but is willing to discontinue if required to optimise healing.  She is, however, frank about the fact that she will need to continue to work since the hospice heavily depends on her.

Communication: things to keep in mind

●      Patients personify “no strings attached”. They are very honest and may sometimes not necessarily be tactful in their truthfulness.

●      They will not conceal any information for their own benefit [3]. These are the patients that will tell you forthrightly that they did not get time to do any of their prescribed exercises since the previous sessions.

The Fraudster

Mrs Pico is a charming, stylish, and well-spoken lady who is seeing you for a follow-up appointment today. She is full of compliments on your attire and cannot thank you enough for how much better she feels after the first consultation. Her headaches are practically gone, but there still seems to be a bit of an issue with her neck. When she elaborates on what was found on her CT brain two years ago, you are taken aback – she definitely did not mention anything about imaging in the previous consultation, even when prompted. To confirm, you access her radiology report online, only to find that she has been sent for an X-ray the just previous day by another physiotherapist. You discreetly try to verify whether she was seeing another professional recently, but she talks it away quickly and effectively.

Communication: things to keep in mind

●      These patients tend to be masters at deception[3] who will select what they disclose and what they leave out in communication. This can potentially complicate your job since you will not necessarily get a comprehensive version of their history first time around. Often with re-evaluation during follow-up appointments, new or contradictory (often significant) information is revealed. You will catch yourself wondering “did I miss this last time?”

●      Be extra diligent to support information gained from the subjective interview with objective tests where possible. When picking up discrepancies, address and clarify.

●      Impression manipulators are often perceived as very flattering[3] and may be vocal and verbal about how much you have helped or meant to them. Appreciate compliments, but always check your objective outcomes for treatment effect as well.

Emotionality

“The Neurotic vs the Hard-core”

High emotionality scorers tend to be sensitive, anxious, stress easily, are quickly agitated and needy of emotional support. Lower emotionality scorers are generally insensitive, independent and fearless.

PERSONALITY  (HEXACO-PI) COMMUNICATION STYLE (CSI)
DOMAIN Emotionality Emotionality
SCORED ACCORDING TO THE FOLLOWING SUBSETS:
  1. Fearfulness
  2. Anxiety
  3. Dependence
  4. Sentimentality
  1. Sentimentality
  2. Worrisomeness
  3. Tension
  4. Defensiveness
TELL-TALE SIGNS OF HIGH SCORERS ●      Anxious in response to stressors

●      Fearful about physical harm

●      Need emotional support

●      Empathic

●      Sentimentally attached to others.

●      Depressed

●      Anxious

●      Irritable

●      Touchy

●      Dependant

TELL-TALE SIGNS OF LOW SCORERS ●      Emotionally detached

●      Seldom express concerns

●      Feel little worry in general

●      Tough

●      Independent

●      Using jokes/irony

●      Fearless

●      Unemotional

●      Undeterred

MORE INTERESTING FACTS High scorers show vocational interest in realistic and investigative careers

The Neurotic

Mrs Henry sighs as she gets up from her chair in the waiting room. She greets with a fleeting smile and little eye contact. When she sits down, she fiddles with her handbag and you can tell from her breathing and shoulders that she is tense. You speak in a friendly, warm tone to her, using a lot of reassurance. With time she seems to warm up and relax a little.  She continues to tell you about her symptoms extensively, elaborating on her long medical history. On questions about family history, she becomes more anxious and emotional when she mentions that her mom has passed on from breast cancer, and that she truly fears getting the disease herself. Her current symptoms have fuelled this worry, and she is desperate for you to help rule it out.

Communication: Things to keep in mind

●      Emotional communicators struggle to express themselves when stressed[3]. A warm, empathic environment is integral, and your patient should feel secure and in a safe space to talk.

●      Keep a box of Kleenex at hand which you can easily hand to your patient if necessary. Stay comfortable if she becomes emotional, but keep your physical distance (e.g. no hugging or embracing, unless you are acquainted with the patient in a different way than clinically only)[12]

●      Remain respectful of the patient’s fears, however mundane they may seem to you. Remember, they are a reality to her.

●      Listen out for any repeating topics from which she may source her concerns and worries[13]. Address them with factual and rational reasoning as early as possible, and keep reinforcing this throughout the treatment course. These fears are often deeply rooted and cannot simply be “erased” by providing a once-off negating argument.

●      Emotional communicators tend to be overly sensitive for criticism[3]. Be careful not to be too frank in your conversation, or seem judging or attacking.

●      Be dominant and firm in your approach[2] albeit gently and tactfully. Take the lead in the implementation of treatment, but keep her actively involved in decision-making. Ultimately, she needs to regain autonomy over her health and not remain dependent upon you – a point that needs to be clearly communicated and implemented.

The Hard-core

Mr Daniel is a professional downhill cyclist who had a bad crash with his bicycle recently. His lower arm was quite sore the day of and after the fall, but he decided to wait and see. On day 3, he went to his local clinic for pain medication. The nurse on duty sent him for X-rays immediately, which revealed a wrist fracture. He had surgery done, and now needs to see you for rehabilitation. He does not think much of his injury, apart from frustration over his compromised bilateral hand function. He is very keen on resuming with his sport and pushes you to speed up the rehabilitation process.

Communication: Things to keep in mind

●      Low-emotionality patients will not likely be driven by fear or anxiety and are able to rationalise their conditions.

●      Patients do not easily show when they are worried, and tend to not talk about concerns spontaneously[3]. It may be wise to regularly check in and ask out about possible concerns, creating a safe forum to disclose any uncertainties.

●      These patients often need to be protected from themselves! They tend to be tough and independent [14]and may discharge themselves from therapy whenever they feel that they have reached the desired outcome. Be frank and comprehensive in terms of education, precautions and contra-indications.

●      Sometimes they tend to be insensitive regarding emotionally loaded, potentially sensitive topics[14]. Remain respectful and try to learn more about what is driving them, even if you do not necessarily agree with their statements.

Extraversion and Expressiveness

“The Boss vs the Gawky”

High scorers are pleasant, enthusiastic people with a high drive, energy and confidence who are comfortable to take the lead or address big crowds. Low scorers are uncomfortable in big groups of people (especially when the focus is on them), they struggle with public speaking and tend to judge themselves and the world in a somewhat pessimistic light.

PERSONALITY  (HEXACO-PI) COMMUNICATION STYLE (CSI)
DOMAIN Extraversion Expressiveness
SCORED ACCORDING TO THE FOLLOWING SUBSETS:
  1. Social self-esteem
  2. Social boldness
  3. Sociability
  4. Liveliness
  1. Talkativeness
  2. Conversational dominance
  3. Humor
  4. Informality
TELL-TALE SIGNS OF HIGH SCORERS ●      High energy

●      Enthusiastic

●      Confidence

●      High self-regard

●      Comfortable speaker

●      Enjoy social interaction

●      Extroverted

●      Eloquent

●      Fluent

●      Socially comfortable

●      Informal

TELL-TALE SIGNS OF LOW SCORERS ●      Negative self-image (see self as unpopular)

●      Awkward in conversation and leadership

●      Tend towards pessimism

●      Withdrawn

●      Snap shut

●      Shy

●      Reserved

●      Self-doubt

MORE INTERESTING FACTS High expressiveness is a common trait in leaders, especially when combined with high preciseness[10]

The Boss

Mr Deacon is a lawyer and CEO of his own law firm. He greets you friendlily, walks briskly to your office and sits himself down. He faces you directly and looks you straight in the eye. He answers a couple of questions on his background and pleasantly engages in some small talk, but comes to the point of his visit rather quickly. He elaborately outlines his exercise regime and describes when and where he first experienced his symptoms. He presents some possible hypotheses that he has considered, and answers your questions in detail. He seems fully in control of the interview.

Communication: Things to keep in mind

●      Patients engaging in high expressiveness will talk a lot and naturally dominate the conversation[3]. You can use this to your advantage and gather as much information as possible. You may need to facilitate the conversation in the correct direction, but if you listen carefully, you could collect a lot of information.

●      Although you are ultimately the one gathering information, give the floor to the patient – he feels comfortable with being in control of conversation[3]. Give good feedback if you grasp what he says, and clarify where you are uncertain.  Firmly but tactfully steer him back onto track if he ventures off.

●      Expressive communicators may tend to  “move into” your space - be it with direct eye contact, sitting slightly too close to you, being very familiar with you or making frequent jokes[3]. This may be interpreted as intended nonverbal communication cues (for example, intimidation or inappropriate affection), but this may often just be how these patients present themselves. Use discretion to differentiate.

The Gawky

Mr Burns, a software developer, seems somewhat awkward from the get-go. He is polite, but shy, and stutters slightly as he explains his complaints. He gives just a sentence or two of information, and as you wait for him to continue, only an awkward silence follows. You need to prompt him by asking specific questions, which he answers bluntly, only elaborating here and there. Gradually, you form a more comprehensive image of his problem. He is visibly relieved when you provide him with accurate feedback of what you understand from the message he conveyed.

Communication: Things to keep in mind

●      These patients do not take the lead in conversation and are not spontaneous communicators [3]. Provide the lead and facilitate the conversation. However, be careful to interrupt them once they get talking, unless there is a definite venturing off track.

●      Fearfulness, withdrawal and passiveness in conversation is often a result of a perceived loss of control. Conversely, when people feel in control, they tend to try harder, be more optimistic and initiate action [15]. When patients struggle with expressiveness, provide a lot of positive feedback and acknowledgement as you gain information, create some structure along which he can give information (a timeline, or concrete questions on symptom behaviour for example) and maintain a warm and empathic approach to create a safe and relaxed environment. 

●      Patients may appear somewhat stiff, stern and uncomfortable. In terms of expressiveness, this does not necessarily imply hostility – they may simply not be good at expressing themselves. Focus on the content conveyed and provide good, supportive feedback to the message transmitted.

●      Be careful not to be too dominant, especially in non-verbal communication. It may be a good idea to relax eye contact for a second and fix your gaze on your notes.

●      Where the patient is truly in his shell, try to gain some insight of his life story and personal interests, and use that as a conversation builder to put him more at ease[16] (For example: You mentioned that your neck was worse after spending a lot of time reading? I know the feeling – once you’ve started a good book, it’s easy to get stuck in one position as time just flies by!)

Agreeableness and Verbal aggressiveness

“The Philanthropist vs the Jerk”

High scorers are nice, peace loving and cooperative people who can easily adapt, control their tempers and compromise. Low scorers tend to be arrogant, self-centred, unpleasant and derogative.

PERSONALITY (HEXACO-PI) COMMUNICATION STYLE (CSI)
DOMAIN Agreeableness Verbal aggressiveness
SCORED ACCORDING TO THE FOLLOWING SUBSETS:
  1. Forgivingness
  2. Gentleness
  3. Flexibility
  4. Patience
  1. Angriness
  2. Authoritarianism
  3. Derogatoriness
  4. Nonsupportiveness
TELL-TALE SIGNS OF HIGH SCORERS (implying low verbal aggressiveness) ●      Cooperative

●      Forgive easily

●      Do not judge, cooperative Compromise selves for others Long temper

●      Sympathetic

●      Pleasant

●      Polite

●      Supportive

●      Cooperative

TELL-TALE SIGNS OF LOW SCORERS ●      Critical and cynical

●      Hold grudges

●      Strongly defend their opinion, Experience anger when not treated well

●      Sarcastic

●      Threatening

●      Cynical

●      Derogative

●      Authoritarian

MORE INTERESTING FACTS Vocationally, agreeable people prefer jobs with strong interpersonal interactions[17].

Agreeable patients prefer affiliative clinicians who communicates with warmth and empathy . Researchers suggests that for patients low in agreeableness, warmth and empathy should also be applied in order to prevent hostility[18]

The Philanthropist

Mrs Truter radiates warmth and a pleasant nature as she greets you with a firm handshake. She immediately notices and enquires about the big Band-aid on your hand where you have burnt yourself the previous day. Being a nurse, she injured her back while lifting a heavy patient. She understands that she will need to perform light duty for a week or two and commits to arrange with her manager accordingly. She is also keen to do her part in her recovery and, although she does not enjoy exercise much, commits to follow her rehabilitation program diligently.

Communication: Things to keep in mind

●      These patients will usually be pleasant and cooperative and may not convey a message of dissatisfaction[3] even if they are not completely happy. Make sure that they are totally satisfied and understand everything and facilitate a friendly forum where they can confidently communicate any discontent.

●      Agreeable patients react very well on strong non-verbal affiliative clinician behaviour (for example, nodding, smiling and looking at the patient[2]

●      Take leadership being the expert, but encourage patients to still actively contribute in shared decision making.

●      These patients are nice, respectful and caring [3]. They will cooperate and you can trust them to do their share in order to enhance the rehabilitation process.

The Jerk

Mr Jackson is known as a bit of a short-tempered grump. He arrives 10 minutes early for his consultation and seems annoyed that he needed to wait for you. As you start your subjective evaluation, he interrupts you, boldly stating that his shoulder has the exact same issue that it had three years ago, and that he requires dry needle therapy to fix it. He is visibly irritated with the fact that you are undeterred and continue your questioning. He unwillingly provides some vague answers and then brashly tells you that you are wasting his time, and demands that you read his medical notes from three years ago and repeat therapy as performed then.

Communication: Things to keep in mind

●      Verbally aggressive patients can sometimes be explosive and intimidating[3]. Unless you have directly contributed to any action that could have lead to discontent from their side, do not be unsettled if they are not behaving in a pleasant manner.

●      Patients high on this spectrum tend to be generally irritable and short-tempered [3]. If a patient is directly rude to you, try not to react emotionally but keep your focus on the task at hand.

●      Remain warm, empathic and patient, and acknowledge their point of view[19][18].

●      Briefly provide a framework of the consultation and what the patient can expect [19]

●      Often times, patients will not necessarily visit you for your opinion, but rather because they want you to perform specific techniques that they deem necessary [19]. In these cases, tactfully insist on first doing an evaluation before any treatment is decided upon and explain to your patient why this is necessary. After assessment, reason with the patient as to why you think/do not think that the specific treatment suggestion made by them is appropriate.

●      Verbally aggressive patients are not the best listeners [3]. Remain concise and to the point when providing any information and make sure that the patient understands [19].

Conscientiousness and Preciseness

“The Perfectionist vs the Scatterbrain”

High scorers communicate in a well-structured way, are concise, engage in meaningful conversation and keep their surroundings tidy. Low scorers tend to be unstructured, impulsive, and not give attention to detail.

PERSONALITY COMMUNICATION STYLE
DOMAIN Conscientiousness Preciseness
SCORED ACCORDING TO THE FOLLOWING SUBSETS:
  1. Organisation
  2. Diligence
  3. Perfectionism
  4. Prudence
  1. Structuredness
  2. Thoughtfulness
  3. Substantiveness
  4. Conciseness
TELL-TALE SIGNS OF HIGH SCORERS Organise their time and physical surroundings, work disciplined, goal-orientated, strive for accuracy and perfection, take time to make decisions. Well thought-out, concise,

Meticulous, business-like, purposeful

TELL-TALE SIGNS OF LOW SCORERS Comfortable with disorder in milieu or schedules, avoid difficult tasks or challenging goals, not focus attention to detail, make impulsive decisions Rambling, unstructured, inconsistent, undirected, long-winded
MORE INTERESTING FACTS Preciseness is an integral trait for good leadership, especially when paired with expressiveness.[10]

The perfectionist

Mr Jordan is an accountant who plays a game of squash at his club every Tuesday evening. He is pleasant, but sparse with his words, providing short, concise answers. When discussing his symptoms, he can tell you exactly how it initially started, point out aggravating factors to the T and show you precisely where discomfort is experienced. He is not confident or comfortable to contribute in discussing a possible hypothesis and waits for you to disclose a diagnosis and detailed treatment plan.

Communication: Things to keep in mind

●      Precision and effective communication is key. Make sure to keep your ducks in a row when leading a conversation! Remain concise and logically structured as far as possible[3]

●      Your statements should be precise and specific rather than generic. Refrain from using too many words and providing too much information.

●      Conscientious people are goal-orientated [10]. Focus on short and midterm goals in your treatment.

●      Be precise in the prescription of exercise and rehabilitation. Include dosage and progression, and precautions/contraindications.

●      Preciseness communicators do not enjoy engaging in insignificant conversation[3]. Minimise superficial small talk. If the opportunity for random conversation arises, talk about more serious or current topics. Comfortable silence is also okay.

The Scatterbrain

Mr Stephens, a local hairdresser, suffers from upper limb pain. He starts his conversation by showing you where exactly he feels the pain on his elbow, and proceeds by saying how tired his arm becomes from handling the heavy hair drier all day. He mentions that he has recently adopted a dog that pulls on its leash severely when walking which not only hurts his elbow, but his shoulder and back as well. He then talks about occasional night pain, but more in his neck – and then starts to explain how he has struggled to find a decent pillow in the last couple of months. Something reminds him of his recent change in his heart medication which he briefly states, and then he points at his elbow again, explaining some more about the nature of the pain.

Communication: Things to keep in mind

●      These patients will chatter away [3]. When they start to move out of context with their conversation, steer them back.  A good way is to pick up on the phrase or idea mentioned before veering off, and probing them to continue along those lines again.

●      Their stories are often conveyed in a somewhat haphazard and unorganised way [3]. Help them create structure by facilitating a concrete framework to stick by (a timeline, or specific symptom behaviour, for example).

●      Make sure you understand what the patient is saying by summarising their main points as you go along.

●      When time allows take heed of their small talk, you might gain a lot of valuable information.

Openness to experience and Questioningness

“The Philosopher vs the Obstinate”

High scorers tend to be inquisitive, to explore new ideas, to reason through thought processes and to appreciate aesthetic beauty. Lower scorers are generally more traditional, compliant and prefer to follow the established route.

PERSONALITY COMMUNICATION STYLE
DOMAIN Openness to Experience Questioningness
SCORED ACCORDING TO THE FOLLOWING SUBSETS:
  1. Aesthetic appreciation
  2. Inquisitiveness
  3. Creativity
  4. Unconventionality
  1. Unconventionality
  2. Philosophicalness
  3. Inquisitiveness
  4. Argumentativeness
TELL-TALE SIGNS OF HIGH SCORERS Appreciative of beauty of art and nature; inquisitive; use their imagination, interested in new or unusual ideas Reflective, philosophical, explorative, passionate, uninhibited
TELL-TALE SIGNS OF LOW SCORERS Less creative, not curious in nature, stick to conventional ideas. Conventional, traditional, compliant, accepting, coherent
MORE INTERESTING FACTS Vocationally strong in social, artistic and enterprising sectors [17]

The Philosopher

Professor Dreyer first takes some time to discuss the latest current newsworthy topic with you before starting to elaborate on his neck pain. He has really put a lot of thought into the origin of its sudden onset and has tried experimenting with different pillows and chairs already. He is wearing a Zen bracelet that his neighbour gave him for pain relief – her explanation of how it works did not quite make sense to him, but he thought there is no harm in trying. During the course of the interview, he makes mention of possible factors of onset a couple of times. When you take out an anatomy model to explain your hypothesis to him, he takes much interest, and asks out extensively, frequently referring back to specific areas on the model.  He seems rather hesitant about one of the aspects of your explanation and keeps reasoning with you about it until you successfully clear it out for him.

Communication: Things to keep in mind

●      These patients are very well equipped to see the bigger picture. They easily engage in abstract thought and like to understand things in context [3]. Take time to educate them thoroughly, explaining the context and origins or their condition/your hypothesis.

●      They tend not to be scared to offer some interesting ideas and points of view[3]. Listen attentively, reason through their contributions and offer constructive feedback.

●      Be prepared for many questions! Explain your thoughts comprehensively, making use of different resources (eg anatomical models, research, etc).

●      Questioning communicators are not scared of conflict and the patient might provide counterarguments in his exploration of the problem. This is not intended to be derogative – it is really important for these patients to understand, and arguments are used to clarify ideas [3]

The Obstinate

Mr Isaacs is a triathlon athlete who suffers from a suspected overuse injury. It is hampering his training and he will do whatever it takes to get it sorted out. He hasn’t put too much thought into the origin of the condition, and states that he rather wanted to come see a professional for a diagnosis and treatment, before he hurts himself even more. After assessment you conclude that an issue in his posterior oblique kinetic chain is most probably the origin of his knee pain. He is happy that you found the source but seems uninterested in your detailed, in-depth explanation. He accepts the recommended rehabilitation without questioning and commits to perform the exercises exactly as you suggested.

Communication: Things to keep in mind

●      These patients tend to not overthink matters and will be happy with a basic, logical explanation.

●      Patients trust your opinion and will not question or reason with you. Make sure that they understand sufficiently, and that you are faultless with your facts.

●      Provide exact and achievable feedback/rehabilitation and teach them how to adjust it if/when necessary (for example, when to increase repetitions of a certain exercise). They will likely not experiment and adjust their treatment recommendations, but rather stick to what they have been instructed to do.

Conclusion

Communication style and personality is the powerhouse package of how any person presents him/herself. If we, as clinicians, can successfully interpret these factors and communicate with each patient accordingly, we can generally expect good clinical outcomes and high patient satisfaction and adherence. We can differentiate between domains of personality and communication, and if we successfully match these to our patients, we can adapt our approach according to the patient’s communication preference.

References

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