Under-Addressed Mediators Of Adherence: Personality In Patients

When novice medical students such as myself learn how to counsel patients, the primary didactic focus is on developing awareness of how factors such as racism, socioeconomic status, environmental stressors, and social supports may predispose patients to or protect patients from acquiring disease and mediating adherence. But in this discussion of patients and the decisions that they may make before, during, and after a clinic visit, we often overlook personality.

As patients with chronic illness require a remarkable amount of medical support, their predisposition to care–their personality–is an important characteristic to know to champion their strengths and mitigate their weaknesses.

Personality traits are organized into distinct categorizations in medical research and associated with downstream behavioral pathways. For example, conscientiousness, one of the Big 5 personalities, positively correlates with medication adherence in patients with multiple sclerosis, among other chronic illnesses. Conscientiousness also negatively associates with higher risk behaviors such as tobacco use and violence. In cancer survivors, conscientiousness negatively correlates with hopelessness.

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Learning about the study of personality as a medical student will promote a nuanced understanding of who patients are and what circumstances they may face in managing their care. This education will enable student-led appraisal of how patient outcomes may change based on patient personality. In one study of patients with chronic illness, a peer-led management program called Homing in on Health (HIOH) increased self-efficacy in patients with low conscientiousness more than in other patients.

Instruction on personality can also promote trainee engagement in using personality research to enhance precision medicine. For instance, data that patients with alcohol overuse had lower conscientiousness guided the development of alternative therapy in the form of advice sessions, which was almost four times as effective as traditional counseling therapy for heavy drinkers. Students can also assist clinics in collecting personality assessment scores longitudinally to facilitate proactive and tailored lifestyle modifications in patients.

Even as a first-year medical student, I spend an allotted time about every other week in a primary care clinic, practicing my physical exam and history-taking skills. Every time I get to the social history, I run through the battery of questions, a familiar yet still foreign language:

“Who are the most important people and supports in your life?”

“Are you able to exercise? Ah, I see. Do you have a designated place, either outdoors or indoors, where you could exercise if you wanted to?”

In every element of this exchange, I experience the personalities of patients. Some are quite vocally frustrated with my questions and scoff at the necessity of them, while others are quiet with prompt nods and shy one-word replies. When we are encouraged to note all relevant and important takeaways from the patient encounter, I wonder where the designated spot is to note these “isms” which give us a deeper glimpse into what our patient is actually like.

Medical students should learn about how personality affects health to better understand their patients’ decision-making processes and enhance innovation in personalized care provision. h

Trisha Kaundinya is a medical student.

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