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16]

Original Article

A descriptive analysis of psychological traits

among the health-care providers
Farah Ahmed, Tahseer Khan, Wajiha Rashid, Soubia Akhtar, Zaeem Ur Rehman Khan, Bilal Ahmed
Dow University of Health Sciences, Karachi, Pakistan

A B S T R A C T
Objective: The objective of this study is to access various personality traits of doctors of hospital subspecialties. Introduction: One of
the most common perceptions in our society is that of medicine being a very stressful profession. The demands of practicing medicine
can have significant effects on general health, work satisfaction, professional, and nonprofessional life. To increase the profitability,
organizations curtail the staff to reduce the costs. Hence, it can be argued that doctors are subjected to extreme amounts psychiatric
duress. Methodology: A descriptive study was conducted in a tertiary care hospital. In which one hundred and twenty-one doctors
were approached randomly varying from different specialties. The short form of the psychopathic personality inventory (PPI-SF) was
used as a questionnaire. Results: One hundred and one (81 females and 20 males) doctors from various specialties responded and
completed the PPI-SF questionnaire. The subspecialty analysis of the doctors’ responses was subdivided into pediatrics, gynecology,
medical specialties, surgery, anesthetics, and radiology. Surgeons and GyneObs were the highest scorers on the PPI-SF, with scores
of 138 and 149, respectively. Conclusion: This study showed that doctors score higher on a scale of psychopathic personality than
the general population. This study also showed that stress immunity is the overriding personality trait in doctors which may, in turn,
facilitate better overall patient care. Stress immunity may better facilitate empathy in certain acute situations, which plays a vital role
in being a proficient doctor and providing satisfactory patient care and counseling.

Keywords: Health-care providers, mental health, psychological traits, psychopathic personality inventory, workload

INTRODUCTION the shear amount of nerve required to make life and

One of the most common perceptions in our society
is that of medicine being a very stressful profession.
The demands of practicing medicine can have
significant effects on general health, work satisfaction,
professional, and nonprofessional life. To increase the
profitability, organizations curtail the staff to reduce
the costs. However, this raises a gigantic question on
compromising of their ease, psychological soundness
and puts an overwhelming burden. [1] Most of the
people do not opt for this noble art just because of
Corresponding Author: Dr. Farah Ahmed,
Dow University of Health Sciences, Postal Code 75850,
Karachi, Pakistan.
E-mail: farahahmed153@gmail.com
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death decisions and that too under extreme pressure.
Hence, it can be argued that doctors are subjected to
extreme amounts psychiatric duress. Factors such
as time pressure to see patients, threat of litigation,
long working hours,[2] and night shifts and divorce,[3]
are some of the leading stressors which disturb the
psychological harmony of doctors. It will, therefore,
not be too surprising that some of the traits associated
with a psychopathic personality (e.g., preternatural
calmness under pressure, or apparent indifference to
human suffering when making life-or-death decisions)
are perhaps selected out in those who rise to the top of
our profession.[4] Can we then assume that most of the
doctors have a personality imbued with psychopathic
traits which make them exceedingly well suited for this
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DOI: Cite this article as: Ahmed F, Khan T, Rashid W, Akhtar S, Khan ZU, Ahmed B.
10.4103/cjhr.cjhr_85_16 A descriptive analysis of psychological traits among the health-care providers.
CHRISMED J Health Res 2017;4:76-80.

76 © 2017 CHRISMED Journal of Health and Research | Published by Wolters Kluwer - Medknow
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Ahmed, et al.: Psychological traits and health care providers
profession? You can further contemplate this might be
one of the factors which separate clinicians from general
population psychologically.
After a thorough search of the scientific literature
worldwide it was observed that the amount of data
accessing psychopathic personality traits in doctors
was scarce. This study was designed as such to access
various personality traits in doctors and to determine
which personality trait predominates.
METHODOLOGY
A descriptive study was conducted within the tertiary
care hospital. In which one hundred and twenty-one
doctors were approached randomly varying from different
specialties. The short form of the psychopathic personality
inventory (PPI-SF) was used as a questionnaire.[5] It was
unnecessary to get an ethics approval since this was a
voluntary process and no patients were involved. The
data were collected in a duration of 2 months starting
from January 1 and ending on February 28, 2016.
The PPI-SF was used as it is a validated short version of
the full-length inventory.[5,6] The PPI is used as a regular
tool in the assessment of mental health. It is divided into
eight subscales [Table 1]. Due to its relative efficiency, a
PPI-SF was developed and has proven useful in many
psychopathy studies.[6] It has eight subscales and is
valid in both forensic and nonforensic settings. Whereas
the long format consists of 187 questions, the PPI-SF
contains only 57. For practical settings where PPI is
considered too time-consuming the PPI-SF is considered
as a valid screening device. It has been validated against
the longer version as a research and assessment tool for
psychiatric assessment.[5] We analyzed the data using
SPSS Version 17.0 IBM Inc.
RESULTS
A total of 101 (81 females and 20 males) doctors from
various specialties responded and completed the PPI-SF
Table 1:The eight subdivisions of the Psychopathic Personality Inventory
Subdivisions
Machiavellian egocentricity
Social potency
Fearlessness
Cold‑heartedness
Impulse nonconformity
Carefree nonplanfulness
Blame externalization
Stress immunity
CHRISMED Journal of Health and Research/Volume 4/Issue 2/April-June 2017
questionnaire (response rate 83%). The overall mean
score was 128 mean score when the PPI-SF was tested
previously on 985 subjects from the general public
was 119.[7]
The subspecialty analysis of the doctors’ responses
was subdivided into pediatrics, gynecology, medical
specialties, surgery, anesthetics, and radiology. The
results are summarized in Table 2. Table 3 shows the
frequency of the highest-scoring personality traits
among the 101 participants. Table 4 indicates the
leading personality traits by specialty.
DISCUSSION
This study clearly demonstrates that stress immunity
is the overriding personality trait in doctors followed
by cold-heartedness. The mean PPI-SF score of 101
doctors accessed was higher than the mean for the
general population (119).[7] It has been shown previously
that high achievers in various professions (including
elite soldiers and company chief executives) are over-
represented among high psychopathic scorers.[8]
Among the hospital subspecialties, the personality traits
associated with gynecologists were Stress immunity,
nonplayfulness, fearlessness, and being carefree.
Surgeons, mostly have the traits of being fearless and
immune to stress. Pediatricians have the personality
traits of being Stress immune, nonplayful, fearless, and
carefree. Anesthesiologists were mostly found to have a
stress-immune and cold-hearted personality. Radiologist,
have the dominant personality traits of being socially
potent and cold-hearted. Whereas doctors practicing
medical specialties have the personality traits of being
immune to stress, care-free, and nonplayful. Stress
immunity was found to be the common personality
trait among all the specialties except radiology in which
cold-heartedness and was the predominant trait.
Among the hospital subspecialists, surgeons and
GyneObs were the highest scorers on the PPI-SF, with
Definitions
Manipulative, egocentric in interactions with others
Charming, influential and able to manipulate others
Eager risk‑taking, no harm anxiety or concern
Guiltless, callous, unreactive to others’ distress
Unconventional, reckless disregard for social normality
Lack of forethought fails to learn from consequences
Rationalises behavior blames others
Absence of arousal in stressful situations
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Ahmed, et al.: Psychological traits and health care providers
Table 2:The mean Psychopathic Personality
Inventory – Short Form scores (out of a maximum of
224) for each of the hospital subspecialties
Specialty
Medical specialties
Surgery
Anesthetics/intensive care
GyneObs
Pediatrics
Radiology
Table 3:The frequency of the highest‑scoring
personality traits from the Psychopathic Personality
Inventory – Short Form among the 101 participants
Psychopathic Personality traits found. The frequencies are given
below
Stress immunity=52
Cold‑heartedness=26
Impulse nonconformity=10
Carefree nonplayfulness=16
Machiavellian egocentricity=6
Social potency=16
Fearlessness=18
Some participants had equal highest scores across more than one trait, so the
total is >101
Table 4:The leading personality traits by specialty
Medical specialties: Stress immunity, carefree, nonplayfulness
Radiology cold‑heartedness: Social potency
Anesthetics stress immunity: Cold‑heartedness
Pediatrics: Stress immunity, fearlessness and carefree,
nonplayfulness
Surgery: Stress immunity, fearlessness
GyneObs: Stress immunity, fearlessness and carefree,
nonplayfulness
scores of 138 and 149, respectively. There is evidence
in the literature that surgeons have the highest levels of
stress.[9] Whether these traits were acquired during their
training period or manifested as a defense mechanism
or were acquired during their practice is debatable.
In various studies performed previously, doctors have
been found to have increased psychiatric tendencies
compared with the general population. An Australian
study using the General Health Questionnaire showed
that doctors had a psychiatric morbidity in 28% of
cases[10] versus 19.5% in the general population.[11]
Our study clearly indicates that stress immunity is the
foremost personality trait among doctors, with higher
PPI-SF scores found in surgeons and pediatricians.
This, however, is not the first study to accesses the
psychotic personality traits in doctors. A British study
using the PPI-SF questionnaire compared the various
personality traits among senior doctors across six
78 CHRISMED Journal of Health and Research/Volume 4/Issue 2/April-June 2017
hospitals and to find out which traits predominate. This
study showed that consultants at teaching hospitals
score higher on a scale of psychopathic personality
Mean score than district general hospital (DGH) consultants, who
126 in turn score higher than the general population.[4] Our
138
120
study, conducted in civil hospital Karachi, also show
149 a similar result with doctors scoring higher on a scale
132 of psychotic personality than the general population.
119
Hence, it would be safe to say that doctors due to their
day-to-day practice in a stress full environment develop
a demeanor which incorporates some psychotic traits to
better deal with the stressors which hinder them from
performing their duties avidly. Factors significantly
associated with psychiatric morbidity in doctors were:
having a current medico-legal matter, not taking a
holiday in the previous year, working long hours, type of
specialty, and having personality traits of neuroticism,
introversion,[9] and the stress of making life and death
decisions to name a few.
This study emphasizes on the role of stress immunity
as an over-riding trait in doctors. Doctors, with a high
level of stress immunity work more efficiently in
difficult and challenging situations where decisions of
grave importance need to be made. This may improve
decision making and may preserve empathy in difficult
situations. This may also benefit doctors applying in
subspecialty training.
Empathy can be defined as the ability to understand
and share another person’s feelings, thoughts and
experiences of either their past of present without
having the experience fully conveyed in an objective
manner. Empathy is commonly regarded as the key
attribute for doctors.[12] There is a conviction that
empathy must be taught to medical students.[13] For
doctors, it is always better to empathetic rather than
being sympathetic. This not only makes them more
genuine caregivers but the patients are also much more
satisfied with the counseling of their doctor when their
doctors are being empathetic. There might be certain
situations where stress immunity may better facilitate
empathy in medical professionals. There may be other
such areas of medical practice that require the doctors’
ability to distance themselves from the subjective world
of the patient.[13]
Measures taken to understand the personality traits
in doctors might be advantageous in their training
and subspecialty selection. This may translate to
better patient care and the patient being grateful and
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Ahmed, et al.: Psychological traits and health care providers
much more satisfied. Patient satisfaction is a multi-
dimensional healthcare construct affected by many
variables.[14] The factors with the clearest relationship to
patient satisfaction include the accessibility of medical
care, the organizational structure of clinics, treatment
length, perceived competence of physicians, clarity and
retention of physicians’ communication to patients,
physicians’ affiliative behavior, physicians’ control,
and patients’ expectations.[15] Understanding which
personality traits are essential for a more proficient
doctor–patient relationship and further working on
instilling them within our medical professionals might
provide a much more satisfactory health-care experience
in the future.
The PPI-SF is a tool which only gives an actual diagnosis
of psychopathic personality when an individual has
high scores across all the subdivisions. The concept of
psychopathy is obviously considerably more complex
than a linear scale of increasing psychopathic tendency
with increasing numerical score.[4] This should be kept
in mind when interpreting the results of this study.
Other means for the assessment for psychopathy
or mental health include the General Health
Questionnaire,[16,17] State-Trait Anxiety Inventory,[18]
the Eysenck Personality Scales,[19,20] and the revised
NEO Personality Inventory.[21,22] However, PPI-SF was
our primary choice because of the validated shorter
number of questions and the personality traits being
accessed so that the questionnaires could be completed
in a timely and convenient fashion.
Questionnaires are prone to some selection bias;
doctors who were curious or who had greater degrees
of experience of the day-to-day stresses of the job may
have been more emphatic to determine their results.
The response rate of 83% in our population was found
out to be more than the physician response rates of
14%–71% published in the literature.[23,24]
CONCLUSION
This study showed that doctors score higher on a scale of
psychopathic personality than the general population.
This study also showed that stress immunity is the
overriding personality trait in doctors which may,
in turn, facilitate better overall patient care. Stress
immunity may better facilitate empathy in certain
acute situations, which plays a vital role in being a
proficient doctor and providing satisfactory patient
care and counseling.
CHRISMED Journal of Health and Research/Volume 4/Issue 2/April-June 2017
Recommendations
It is still not known if there are any particular personality
traits which are beneficial in patient-centered care
when working in a team setting and further studies
are required to evaluate the personality traits and the
variation in personality scores in this particular area.
It is also recommended that we evaluate the personality
traits and the variation in personality scores among
teaching hospital consultants versus DGH consultants
and correlate the career advantages conferred by the
personality traits among the two in various setups to
make the data more authentic.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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