Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Conflicting Personalities

If certain personalities should not marry each other, it would seem logical that doctors with some personalities should not be treating some types of patients.”

There are several personality types that are going to clash, and we should examine them:

a. The narcissistic doctor and patient: an injured worker may express narcissism differently from his doctor. The doctor’s narcissism may present as over investment in image, acclaim and others’ deference to his authority. The patient’s narcissism may surround physical traits or material possessions. Regardless of the differences in expression, the two will invariably clash because each places their image and self-importance higher than the mutual task at hand – managing the problem which brought the patient to the office. What ensues is a power struggle wherein the patient attempts to prove his independence from the doctor’s care, and the doctor becomes invested in displaying his control.

b. The negativistic (passive-aggressive) doctor and patient: In this conflict, both physician and patient have appreciable hostility that each feels it unwise to directly express. The patient, therefore, arrives late for appointments, provides a deliberately incomplete history, and/or is arbitrary in his compliance with treatment. The physician lets the patient wait for extended periods, fails to call in medication on time and minimizes the complaints that the patient verbalizes.

c. The paranoid doctor and patient: Both doctor and patient are distrustful of each other. The doctor feels that the patient is solely there for purposes of ripping off his employer/insurer and that all symptoms are feigned or, at a minimum, exaggerated. The patient feels that the doctor works for his employer, has no intention of finding the source for his complaints, is indifferent to his suffering and solely does this for the money.

d. The dependent doctor and patient: The doctor has good objective data, but he is uncertain as to whether his referral source will be pleased with it. He does not voice his diagnosis until he knows in advance that those who referred the patient will accept the diagnosis. He reports one thing to the patient, then changes that assessment when he learns that others prefer that the findings be less significant. The patient cannot understand this pattern and becomes frightened. He is certain that he can neither recover or transfer care to another office. He clings, entreats and pleads with staff.

Conflict is not confined to these combinations, either. By definition, a personality disorder is a pattern of response that interferes with effective functioning and interpersonal relationships.

All such situations are ultimately manageable/modifiable if personality incompatibilities are recognized. However, often there is little to no awareness of what is occurring and how the conflicts are impeding the course of recovery. The first step is listening to both doctor and patient, clarifying contradictory statements, and not placing yourself squarely in the middle of a conflict.”

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