Health Care Communication Using Personality Type: Patients are Different!
By Judy Allen and Susan A. Brock. Routledge, 2000. £12.99 (PB), 213 pp. ISBN 0‐41521‐374‐6
This book stresses the importance of effective communication in health care and recognizes that communication skills are becoming an integral part of professional training. Patients are viewed as having varying needs and priorities when consulting with a health professional. The authors contend that because most existing models of communication assume that all patients react in the same way, there is a need for a new framework, which takes patient differences into account. The Myers–Briggs Type Indicator (MBTI) is presented as the most suitable tool for this purpose which in its purest form is a psychometric test. The MBTI is derived from the theory of psychological type preference that was first explored by Swiss psychologist Carl Jung. The psychological theory was later adapted by Isabel Myers and Katherine Briggs who attempted to make it accessible to a wider audience. It has since been used extensively in industry for understanding differences in people and how these affect behaviour and communication. The authors present a model, based on the MBTI, that they have developed for applying type preference to health care communication called FLEX Care.
Throughout the book there are case studies and numerous examples of how to apply type theory. At the end of each chapter there is a helpful summary and exercises for readers to complete should they have time. The theory and its applications are explained in a logical and clear way, although the constant use of short‐forms is at times a little confusing. In the first two chapters the authors introduce the theory of the MBTI and the structure of FLEX Care. There are four main scales that when combined form 16 different ‘types’ or preferences. These are identified in a shorthand form by their first letter, for example, ESTJ = Extraversion, Sensing, Thinking and Judging. Examples are provided of characteristics frequently associated with each type. For example, people with a Sensing and Thinking (ST) preference tend to prefer to hear ‘the facts’. The authors contend that individuals use all preferences at various times and that observation of an individual's behaviour cues will identify their ‘type mode’ as it currently presents itself. The reader is invited to consider his or her own preferences and how these might affect communication as a patient and a practitioner. Examples of behaviour cues indicating specific ‘type modes’ are given and specific ways to respond to individuals in various ‘type modes’ are highlighted. For example, those who prefer Specifics/Impact on people (SF) say their preferences for communication in a health care setting are: be friendly, caring, cheerful, listen to me, treat me as a person, ensure privacy, be efficient. However, after reading all the preferences for each type I felt that, as a patient, I could subscribe to most of them irrespective of type.
In Chapter 3, case study interviews of patients and health care professionals concerning critical incidents in health care are presented. The reader is invited to use his/her knowledge from the previous section and use the type preference cues exhibited to ascertain the ‘type mode’ of the individual concerned in each example. Whilst some interesting examples are presented I was not totally convinced by the type preferences attributed to each critical incident by the authors. For example, in the case of David, the senior oncology nurse, we are asked to look for evidence of Extraversion, Intuition and Feeling and Perceiving (ENFP). After reading the positive critical incident, I felt it was a good example of the use of non‐directive counselling skills by this male nurse rather than a demonstration of a particular personality type.
The book goes on to explain how psychological type theory might assist health professionals when breaking bad news to patients and how it can help achieve informed decision‐making, which in turn may facilitate adherence. The advantage of using FLEX Care when breaking bad news is that it encourages health professionals to take their cue from the patient rather than relying on a fixed model. Furthermore, it encourages self‐awareness, as health professionals are encouraged to consider their own type preferences, which are often very different from patients'. However, the FLEX preferences in relation to bad news are derived from data collected from a small group of palliative care nurses, a very select sample.
The chapter on working together is informative and includes a discussion of the role of written communication in team‐work. The section on organizational character and personality type relates more to organizational psychology and hence seems rather out of place as does lengthy Chapter 7, which focuses on personal and professional development using type theory. The book concludes by introducing a model of communication that is independent of the MBTI. Ironically, I found this to be one of the most useful chapters as it describes a model that can be used to encourage positive and creative exchanges in the most difficult circumstances.
Few details are provided concerning the participants involved in the original research that underpins FLEX Care. The data, used to investigate whether type preference affects communication, were collected from individuals working in settings, unrelated to health care, for example, sales and consulting. We are told that data were gathered from ‘several hundred individuals who had verified their type preference’. Participants were asked questions such as ‘How do you prefer to be sold to?’ Further data relating type to health care were then collected and individuals were asked questions including ‘What’s most important to me?' in a variety of health care situations. The use of a hypothetical research questionnaire makes it difficult to assess how reliable this theory is in practice. Surely the skill for the practitioner is to elicit from patients what they want in terms of health information and their involvement in the decision‐making process rather than rely on psychological theory in order to deduce these preferences.
Yes, patients are different, and they do exhibit a range of behavioural cues, but not just because of their personalities. FLEX Care neglects the fact that many individuals have past experiences of illness (negative and positive) and hold specific health beliefs, which influence the way they behave, cope and react in a health care environment. It is these aspects which all too often remain unexplored by health professionals and which could potentially reveal useful information in terms of finding the most appropriate management path, i.e. one that considers the preferences and values of the individual patient in question.
Sarah Ford, Ethox, University of Oxford, Oxford