Personality is a complex concept—and an important one: it reflects human beings’ basic psychological infrastructure.1,2 This means that it plays a critical role in determining how people live their lives and negotiate the myriad challenges that life presents. In medicine, personality has direct effects on the propensity to seek health care, the ease and accuracy of providing a medical history, adherence to treatment, and the adequacy of health-related social support networks. It further predicts self-care and lifestyle issues, for example choice of employment (or profession), eating and drinking habits, exercise, and risk-taking behaviors, including substance use and sexual habits.3
In Chapter 5 on anxiety disorders we discussed the difference between obsessive compulsive disorder (OCD) and obsessive compulsive personality disorder, the major difference being patients with OCD are anxious and distressed by their thoughts and behaviors while those with the personality disorder are not.
Before discussing these and other personality disorders, however, let’s first expand on another point from Chapter 5: that many obsessive and compulsive personality traits reflect neither OCD nor obsessive compulsive personality disorder. Like all personality traits, most are quite normal—defined as functioning to help people adapt most effectively to life, which is especially important in choosing a life pathway or career.4 We described the adaptive features of obsessive and compulsive traits with the example of their being necessary for becoming a successful surgeon, while other personality traits also are valuable in becoming a successful physician—or any other person—such as the importance of dependency traits for a successful marriage or of histrionic traits for making one attractive.
Adaptive dependency personality traits, for example, are one of these essential traits for all people and associated to “attachments” so vital to making and maintaining human relationships. Medical students and residents are dependent on faculty to provide them with the education and training required to become successful physicians and to function with increasing independence in their patient care. In contemporary medical practice we are all dependent on multilayered systems involved in the care of our patients. These systems involve other health care professionals we are dependent on from the various levels of nursing personnel, to laboratory technicians, to pharmacists. We are also dependent on each other for consultation and coverage. Primary care practitioners are dependent on a wide range of fellow professionals and paraprofessionals from the pathologist who provides biopsy reports to their “front-office” personnel and secretaries who schedule appointments and maintain efficient patient flow.
Adaptive personality traits of suspiciousness are also very important because clinicians are detectives who investigate all forms of injury and illness. Suspiciousness informs our judgments from the workups for each individual patient to being more attentive and wary of the knowledge and skill levels of a senior medical student compared to those of a senior or chief resident. It is also a good practice to be more wary of ...