Most healthcare professionals believe that interprofessional working is a good idea in principle. Why, then, is it so difficult to implement in practice? This is the question Zubin Austin, academic director of the Centre for Practice Excellence at the Leslie Dan Faculty of Pharmacy at the University of Toronto, attempted to tackle at the Royal Pharmaceutical Society’s annual conference on Sunday 4 September. The answer, he suggested, lies in the general personal traits of “pharmacists” versus “physicians [doctors]” and how they are taught at university.
Austin began by describing five scales of personality traits: openness – the extent to which an individual derives psychological comfort from novelty as opposed to routine; conscientiousness – the extent to which an individual derives psychological comfort from rules; agreeableness – the extent to which it is more important to be liked rather than correct; extroversion – the extent to which an individual derives or expends energy from spending time with others; neuroticism – the extent to which an individual is comfortable with themselves as a person. He explained that pharmacists were more likely to identify as preferring routine, organisation, aloofness, introversion and sensitivity respectively, whereas doctors tended to novelty, carelessness, friendliness, extroversion and confidence.
Additionally, he explained, pharmacists tend to approach challenges in a ‘story-oriented’ manner, meaning that they are more likely to consider a problem from first principles. This may be because of the manner in which they are taught in pharmacy schools – starting with a firm basis in anatomy and pharmacology and working upwards from there. In contrast, doctors are more likely to tackle things in a ‘problem-oriented’ manner, spotting patterns and making quick decisions.
“Your colleagues who study medicine are never burdened by the basics any more. They just get right in there and develop pattern-recognition,” Austin commented.
These traits have implications for how these practitioners approach interprofessional working, he added. “We require an ability to trust that people know their jobs and do what they are supposed to do in order to function in the world,” he notes. “It appears as though pharmacists and family physicians have a very different cognitive model of trust.” For example, pharmacists are more likely to trust other professionals based on their credentials and qualifications. “Pharmacists are generally hardwired to think ‘you’re a GP so I’m going to trust you’,” Austin said. Doctors are more likely to require personal experience and a history with another professional – medical or otherwise – before they would be inclined to trust them.
“This has huge implications for interprofessional relations,” Austin explained, “because if I give you trust freely but, in response, you expect me to earn your trust, I think you’re a bully and a know-it-all.”
Likewise, styles of communication can vary between story-oriented and problem-oriented individuals. Austin noted that, when a doctor asked which drug is better, X or Y, a pharmacist is likely to give a long description of the advantages and disadvantages of each drug, adding which other drugs are available as extra information. However, the doctor is more likely to require a direct decision – drug X is better.
Austin also described the importance of self-confidence – and how this might mean different things to different professionals. Story-oriented individuals are more likely to want to be certain that they are giving the correct answer to a problem, even if this means taking more time to reach a decision. Problem-oriented individuals, conversely, are more likely to make a faster decision but be more relaxed about handling the consequences if the decision turns out to be incorrect.
“We tend to believe that people that look, sound and act like us are the right kind of people,” Austin said. “If we register difference as bad and not necessarily as different, we are not off to the best start for interprofessional learning.”
However, Austin was keen to stress that having a mix of personality traits were not necessarily a bad thing. Although it can make it difficult to collaborate and lead to frustration, it is also helpful to have a mixture of perspectives and attitudes within teams to ensure that, for example, rules are abided to when necessary and broken when necessary.
So, how strongly do you identify with these personality traits and problem-solving styles? Do you fit into these descriptions and can you see these traits in others?