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Type at the Family Conference Table

Written by Mathew David Pauley, JD, MA, MDR Strewn throughout hospitals are conference rooms primarily devoted to provider-patient discussions.  No, that is not entirely accurate—providers meet their patients bedside.  So, it is more precise to say that these meeting spaces are used by providers meeting with family members.  They are meeting with family members probably because their patients are too sick to participate in the decisions about their health, and the people who love the patient are there to help make those important decisions on the patients’ behalf.

Physicians and nurses are the providers we most often think about, but there are other individuals who may be present, such as social workers, case managers, and chaplains. It’s within these conference rooms, primarily within intensive care units, where families are frequently presented with some of the most difficult news of their lives, and where they are confronted with the hell of choosing the best of several heart-breaking options.  And it is within this context where I began to see type dynamics playout.  As a practicing clinical ethicist, one of my primary roles is to facilitate discussions among providers, patients and family members around morally difficult issues—and I see conflict and uncertainty emerging in a myriad of unique ways.

I began seeing Type dynamics play out in care conferences in tandem with my introduction to personality preferences.  At the time, I was a new fellow in the California Health Care Foundation’s Leadership Program. The fellowship began with, and continued to have, sessions on type. For me, and likely many of my colleagues, personality type provided a cohesive structure to understand one’s preferences and needs with regards to taking in information and making decisions. Once I returned from my first seminar, I started to apply what I learned.

How do we talk about disability and death? Not in an abstract way, like one may have in a classroom or on a long car trip after hearing a podcast on the subject, but when disability and death are immediately before you.  Where does one wish to focus and what information matters?  Our patients’ values and wishes are by their nature future focused and theoretical, but achieving them will be near impossible without a thorough and honest look at panoply of medical data they present to the providers. And with that in mind, let me re-word a well-known preference-driven question: Who would you prefer to work with in the Intensive Care Unit, a physician who is exceedingly thorough and precise but communicates without tact or concern for families’ values, or a physician who is warm, welcoming and willing to listen but may not dig deeply through the patient’s medical record?  Thankfully, physicians are able to be much more well-rounded people and find the balance between accommodating the emotional needs of the family while bringing the full weight of their clinical expertise to the patient’s bedside. The question highlights the question of preferences—some families prefer the soft human touch while others need the facts, blunt and without any pulled punches. And similarly, physicians may prefer softer language to temper how bad the news is, while others prefer to lay everything on the table.  As is with life, frequently the preferences amongst providers and families do not sync as well as one would hope.

A few months later, there was another seminar with the CHCF; this time we spent four hours on core functions, Type under stress and the “grip experience.” I thought back to my conference room meetings, filled with chronically stressed physicians and nurses and patients’ family members reaching their breaking point.  This session seemed to pose the question, “Who exactly was sitting at that care conference table?” Was the spouse who emotionally erupted midway through the meeting, cursing out the physician an extraverted feeling type? Was the parent of the sick child obsessing over a single vital sign in lieu of the seeing the full breadth of the disease an introverted sensing type? The cruel irony that people are left to make some of the hardest decisions in their lives when they are, mentally and emotionally, at their worst had always been apparent to me.  Again, type dynamics provided a coherent explanation of what was going on. Moreover, improving one’s understanding of personality type provides strategies to better address these impediments and (hopefully) improve the decision-making process.

In future blog entries, I will be exploring Type at the family conference table and in hospitals generally.

About the Author: Mathew David Pauley, JD, MA, MDR is going into his 10th year as a practicing clinical ethicist. His background has primarily focused on conflict resolution, negotiation and mediation as it relates to ethical decision-making and values-based disputes. Last year, Mathew became a MBTI Master Practitioner and has been applying type to his practice.