The doctor in the consultation room: personality traits and shared decisions with patients

The research question

A Japanese study compared a brief measure of Big Five traits in 43 doctors with ratings of shared decision-making involving 493 patients with lupus. It asked an interesting question: are doctors’ traits associated with how patients’ involvement in choosing a course of action is rated? Even if such a link appears in the group studied, it does not describe every doctor with a similar profile. Nor does it show, on its own, whether a patient in a particular consultation learned about the options and had a chance to express their views. When reading the findings, it matters who rated the conversation and how. Only then is it possible to judge what the observed association concerns.

A measure with limitations

A brief Big Five questionnaire offers some insight into traits, but not a complete picture of a doctor’s personality. The study was cross-sectional: measuring traits and rating shared decision-making cannot establish that a trait caused a conversation to unfold in a particular way. The context also matters: one condition and one study population in Japan. The findings should not be applied to other specialties, patients, or working conditions without further testing. Survey ratings must also be distinguished from observations of an entire consultation. If the measure relied on participants’ responses, it reflects what they reported or experienced; it does not reconstruct every question asked or explanation given in the patient’s presence.

What patients can observe

Shared decision-making becomes visible to patients when a doctor presents genuine options, rather than only a ready-made recommendation. The doctor should explain each option clearly, including potential benefits and burdens. It is then worth asking how the patient weighs these considerations in their own circumstances: what matters most to them and which possible outcomes worry them. Patients can use this to assess their experience of the conversation: whether they learned about the available paths, understand their possible consequences, and had room to express their priorities. This does not require assigning the doctor a personality type. It focuses attention on behaviors that can be heard and checked during a visit.

When the conversation stalls

When a conversation about a choice stalls, the doctor can return to the two options under consideration and ask what the patient still needs in order to decide. A brief reply may conceal a specific concern or a goal that has not yet been voiced. It is worth asking what lies behind the hesitation instead of simply repeating the recommendation. If some information remains uncertain, the doctor should say so honestly while explaining the plan for further tests and agreeing on when to revisit the choice. A review of how diagnostic uncertainty is communicated between doctors and patients helps distinguish this kind of explanation from simply putting off a clinical decision. Uncertainty need not mean there is no next step.

Traits and training

An association between a trait and a rating of a conversation is no reason to select doctors based on a single brief test. Personality traits do not determine how someone will conduct every visit, and a questionnaire score cannot replace observing their work. Specific skills, however, can be developed: presenting options clearly, explaining their implications, listening to responses, and returning to the question of patient preferences. Practicing with examples from real consultations can reveal when a doctor moves too quickly to a recommendation or leaves no room for questions. Assessment should focus on these behaviors in conversation, not a presumed personality “type” or an expectation that all doctors will communicate in the same way.

Patient preferences

Involvement in a decision need not look the same for every patient. One person may want to compare options in detail; another may prefer a shorter explanation and a stronger recommendation from the doctor. After presenting the options, it is therefore worth asking how the patient would like to take part in the choice and how much information they need. It also helps to ask which possible treatment outcome matters most to them and how much time they need to think. Inviting questions and checking how the patient understands the available paths can bring misunderstandings to light. Simply agreeing to a proposed course of action does not yet show that the patient learned about alternatives and made an informed choice aligned with their priorities.

The limits of the findings

The most important limit is straightforward: a correlation in a cross-sectional study does not establish that changing a doctor’s trait would improve shared decision-making. Nor can it be used to assess an individual doctor’s quality or predict a patient’s treatment outcome. The study involved 43 doctors and 493 people with lupus in Japan, and traits were described using brief Big Five measures. These limitations matter before anyone turns the findings into a professional assessment or a plan to rank staff. Instead, it is worth asking patients whether they understood the options, could express their preferences, and know what plan they agreed on together. That feedback concerns their experience of the decision, not assumptions about the personality of the person leading the visit.

A link between doctors’ traits and ratings of shared decision-making is no basis for ranking “good personality types.” In consultations, it is more useful to work on presenting options, asking about priorities, and checking understanding.

Empatyzer and conversations about decisions with patients

Before a visit to discuss two reasonable ways forward, a doctor can begin by examining their own habits. In “About Me,” they can check whether they tend to move quickly from explaining the situation to making a recommendation, and how they usually present options to patients. Then, in a conversation with Em, they can prepare a simple explanation of both paths without assuming which one the patient will choose. Em helps them frame a question about the patient’s priorities and values, practice asking which path the patient prefers, and check whether the explanation was understood. Micro-lessons can serve as reminders to leave room for thought and questions. The aim is not to change a personality test score or predict the patient’s decision. It is to present the choice clearly during the consultation, hear what matters to this person, and only then agree on the next step together.