What are the characteristics that make a doctor, nurse, technician, dietitian, social worker, or administrator effective with their patients? What differentiates the personal success of a healthcare professional between those that are not so successful? Would you say it is their technical skills, such as proper documentation of procedures, administering appropriate amounts of solution, or understanding dialysis equipment?
Relational vs. Technical Skills
Would their relational skills be more important? This would include the professional’s ability to manage conflict in the treatment room, maintain a warm environment for the patient, and possess an understanding of each patient’s social needs and personality type.
I maintain that almost anyone can learn technical skills with study, observation, time and practice. Being able to demonstrate the ability to communicate, manage conflict, and connect with each patient’s personality type is an art that few possess, however.
Obviously, both technical and relational skills are required for best results in renal care. Nonetheless, the higher percentage of those working in the field of medicine excel in one or the other of these skills, but not in both.
Basic Hippocratic Personality Types
In the 4th century BC, Hippocrates, the Greek Western Father of Medicine, developed the theory that people in general possess four basic different personality types. He maintained that different levels of body fluids determined the four types of behavior.
Following are the personality types, according to Hippocrates:
- Melancholic. The Greek doctor suggested that those with higher levels of black bile were found to be more serious, moody, thoughtful, and detailed. He referred to these individuals as “melancholic.”
- Choleric. Hippocrates then proposed that those with more yellow bile seemed to have higher occasions of angry outbursts, a sense of drive and intense passion and referred to them as “choleric.”
- Sanguine. Those with pronounced levels of rich blood were associated with being more excitable and optimistic, yet unpredictable, and they were categorized as “sanguine.”
- Phlegmatic. Wisdom from the ancient physician also suggested that those with bodily phlegm were slow moving, relaxed, and more difficult to motivate. He termed them “phlegmatic.”
Although medicine eventually ruled out this theory regarding “body fluid levels” being the determining factor behind the four behaviors, the four basic temperaments have withstood the test of scrutiny and have been accepted and established for centuries.
Personality Strengths and Weaknesses
To be a more effective staff member in dialysis, I propose that learning your patient’s personality type and treating them accordingly will yield improved relational results between you, your patients, and their families. To better “connect” with your patients, I will briefly list some identifying strengths and weaknesses of the four personality types:
Melancholic Patients (Introverts)
Detail oriented Worries frequently
Structured and orderly Overwhelmed with life
Knows and follows rules Unrealistic expectations
Well-mannered and appropriate Suspicious
Caring Hard to win back if offended
Choleric Patients (Extroverts)
Knowledgeable “Never wrong”
Strong disposition Argumentative
Successful in life (generally) Intimidating
Quick to learn Bottom-line communicators
Usually correct “in principle” Impatient
Sanguine Patients (Extroverts)
Good communicators Too loud
Loves people Breaks confidences
Optimistic Runs late
Friendly Lives in denial
Popular No boundaries
Phlegmatic Patients (Introverts)
Easy going People pleasers
Compliant Sends mixed messages
Kind Hard to motivate
Likeable Won’t tell you what’s wrong
Obviously, due to these differences, you would be limited in your personal effectiveness if you only had one way of relating to each and every patient. It is highly recommended for best results that you learn the “personality language” of your patients since each individual is different and sees his care and life through a variety of colored lenses.
Relating to Your Patient’s Personality Type
Choleric Patients: “Do It My Way”
Since cholerics are quick to learn, they put a high premium on your ability to give concise instructions and expect you to have a well-rounded knowledge base. They are generally not given to much chitchat but want to know the “black and white” facts about their progress and care.
Patients with choleric tendencies would prefer to be in control and take charge as much as possible since that has been their disposition since childhood. They like being respected for their abilities to make decisions and do better when they are able to be self-sufficient. If such patients get too demanding, you have to quickly command their respect. Do not let them see you as indecisive and weak or they will lose respect.
Melancholy Patients: “Do it the Right Way”
Patients who are melancholic are given to much detail, and everything is about proper procedure and order. It’s a common phenomenon for them to know as much or more of what the policy/procedure manual contains than staff members. Since everything must be done with the highest quality and standard, they would be quick to ask questions and point out discrepancies with their care. They enjoy what is routine and struggle with change.
Since security is so critical to patients with melancholy, they depend on consistent order. This includes having the same dialysis chair and the same shift and staff. They would be more “territorial” than the other personalities. Nothing less than quality and “professional” care is acceptable to the melancholic. To be unorganized and lax in your care would be totally unacceptable. Always let these patients know in advance if there are procedural changes coming and know for sure that they would prefer a quiet environment at their station.
Phlegmatic Patients: “Do It the Easy Way.”
The most adaptable of all patients, phlegmatic individuals are the easiest to please. They are extremely methodical and practical in their thinking. When asked for logical and practical advice, they generally find the best solutions or, at least, an easier way to accomplish a task.
Phlegmatics are better listeners than speakers. If you seek their input, they will usually weigh their answer against what the majority feels or against the level of conflict that could result. They would be the least tolerant and most inwardly disturbed if staff or patients are not getting along because they naturally give the benefit of the doubt to everyone. You must create an environment of acceptance in order for them to be truly honest regarding how they are feeling. In addition, most are soft spoken and are not given to drama. If approached rationally, they will discuss anything with you.
Sanguine Patients: “Do it the Enjoyable Way”
Sanguines do not understand why even dialysis can’t be done in an enjoyable way. They are optimistic individuals who can put a positive spin on almost any situation. They enjoy people, are friendly, and excel in communication. They are most likely the loudest patients in the unit. It’s important that they sense the approval of all. Punctuality is not their strong suit, so they can jam up scheduling. They are so likeable, however, that they probably get away with more than others.
These individuals are excellent in making “new” staff or patients feel comfortable and accepted. They are the “public relations” patients and see everyone in their unit as part of their family. On occasion, they may break confidence, not because they are disloyal, but because they have forgotten what secrets they committed to. Sanguines focus on the present and have a hard time facing reality at times. Since they are extremely forgiving with other people’s shortcomings, they hope for the same understanding from others.
In my opinion, the inability to “connect” with your patient’s personality type will leave loose wires dangling with less power and effective results in your overall standard for healthcare. If you make the investment to better understand those patients under your watch, however, your treatment of them as well as your work experience will be enhanced and, ultimately, more effective.
About the Author
Bill Gallagher is the founder of Teamworks in Medford, OR. As a counselor and motivational speaker for 25 years, he emphasizes the need for improving quality care and staff morale. Bill’s wife, Jenny, is the nurse manager of Home Dialysis at RogueValley Dialysis Services in Southern Oregon. The author has been conducting workshops and mediation sessions for dialysis center staff and speaking at healthcare conventions and meetings for six years. For more information on Teamworks services or to take your free personality profile, go to: www.teamworks-works.com.
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