Physicians Anonymous

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Physician personality traits and burnout

Is there such a thing as a “physician personality”? Several personality traits have been found to occur more commonly in doctors. There is some variation in traits by specialty, but broadly we are a careful and caring group, prone to care too much and work too hard. Resultantly, our patients get the best of us, but sometimes we give too much or care about ourselves too little. In this article, we explore physician personality traits and burnout.

Common physician personality traits

A bit of attention to detail — obsessionality — is desirable in an airline pilot, anesthesiologist, and brain surgeon. I would not want a lackadaisical person in charge of my flight/anesthetic/craniotomy. Hard-working, dedicated, resourceful, caring – these are all desirable characteristics in our healers and carers. God knows, we need to be the first 3 to survive med school and specialist training

Furthermore, our personality traits and values seem to predict specialty choice to some degree, or at least some traits cluster more in some specialties. Some specialties score higher in empathy, others in obsessionality, others in neuroticism or openness.

Nevertheless, in the interests of harmony, we won’t go into the differences in IQ and hand-grip strength between different specialists. Suffice it to say that Orthopedic Surgeons seem to win, at least in this study from the British Medical Journal.

So, medicine selects for these traits and encourages them (even exploits them) throughout our medical careers. Yet too much of a good thing may not always be good.

The downsides of physician personality traits

However, personality traits are a double-edged sword. While traits like conscientiousness, agreeableness, neuroticism are helpful in being a successful and safe clinician, they can have their downsides. Moreover, in extremes they can contribute to burnout, depression, and worse:

  • Conscientiousness in excess can lead to obsessional thinking (let’s count the swabs just one more time);
  • Agreeableness can result in never feeling able to say no;
  • Neurosis can drive us to chronic self-doubt;
  • Guilt: while this can be a motivator, in excess it can contribute to feelings of worthlessness and depression;
  • Self-denial: an important trait when you are a resident in need of sleep, but the only person available to treat a pneumothorax. I marvel at how accustomed I became to self-denial – at least until my addiction kicked in (but that is another story).

While traits like conscientiousness, agreeableness, neuroticism are helpful in being a successful and safe clinician, they can have their downsides.

  • Harm avoidance: reflects a tendency towards anxiety and pessimism in anticipation of problems. Clinicians who are low in harm avoidance are decisive and less anxious. The converse is true, and a desire to avoid all harm can lead to over investigation or over treatment;
  • Persistence: reflects a bias towards maintaining behaviour with stamina despite frustration, fatigue, or discouragement. The downside is that high persistence can also be associated with perfectionism, which can lead to burnout or depression. We can learn to avoid the risks of perfectionism and other pitfalls of being overly persistent by identifying and accepting our limitations, learning from failures, and setting realistic goals.

The “disruptive doctor” and physician personality

The best overall strategy is prevention. Most physicians don’t plan to be disruptive, it’s just that things may get in the way.

A less charitable comment on physician personality comes from work published  on “disruptive physicians” by Internist Alan H Rosenstein MD MBA:

“Physicians are by nature very competitive, task driven, perfectionists, with very strong egocentric personalities. Medical training further accentuates the problem with its focus on gaining scientific knowledge (at the expense of developing interpersonal skills) which breeds a sense of autonomy, dominance, and need to control (at the expense of emotional sensitivity). All these factors can lead to a challenging personality who may at time be difficult to deal with.”

While the language used triggers some of my own personality traits, there is a kernel of truth. Man of us have seen the physician described above. And, to be fair, Rosenstein focuses on systemic issues before individual personalities. He makes a further redeeming counterpoint:

“The best overall strategy is prevention. Most physicians don’t plan to be disruptive, it’s just that things may get in the way.”

Coaching and physician personality

Professional coaching, long utilized in the business world, provides a results-oriented and stigma-free method to address burnout, primarily by increasing one’s internal locus of control. Coaching enhances self-awareness, drawing on individual strengths, questioning self-defeating thoughts and beliefs, examining new perspectives, and aligning personal values with professional duties. 

Broadly, coaching utilizes established techniques to increase one’s sense of accomplishment, purpose, and engagement, all critical in ameliorating burnout. Professional coaches presume that the client already possesses strengths and skills to handle life’s challenges, but is not accessing them optimally. Although an evidence base is not fully established, the theoretical basis of coaching’s efficacy derives from the fields of positive psychology, mindfulness, and self-determination theory. Physician coaching has been proposed as one approach to tackling physician burnout.

Professional coaching provides a results-oriented and stigma-free method to address burnout, primarily by increasing one’s internal locus of control.

Conclusions

Physician personality traits can help us succeed in this most challenging and rewarding of vocations. However our personality traits in extreme or exacerbated by chronic stress can become unhelpful. If we are struggling, we can seek help through coaching, therapy, or medication However confidentiality is often a barrier for physicians. Furthermore, disclosure of psychiatric treatment is increasingly required by licensing bodies, and this can be a further barrier.

If you need psychiatric treatment, we urge you to get it. Physicians Anonymous is not a treatment program.

At Physicians Anonymous we use an approach blending coaching and group peer support. Peer support allows for honest yet compassionate feedback from our equals in a safe space for physicians.

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