In clinical practice, a communication between a
doctor and his/her patient could be an interesting observation.
Individual personality can significantly influence the interpersonal
communication and its outcome during such interaction. Human behaviors
could be likened to the acids and bases in organic chemistry. While
extremes of pH prove to be corrosive and caustic respectively, neutral
pH is the most ideal situation for ensuring homeostasis. Accordingly, it
is easy to imagine what happens when two people with highly acidic or
highly alkaline personalities interact. To salvage such situations, we
would ideally need an alkaline buffer to interact with a strong acid,
Every doctor caring for his/her patient expects the
patient to be obedient, to follow what he/she says, and to respond in a
way that is expected out of him. However, this does not happen most of
the times. We very often encounter funny and occasionally serious
confrontations with our patients, and then keep wondering what exactly
went wrong despite us doing a good job (especially in case of young
doctors!). According to "my modification" of Henderson-Hasselbalch
equation, we broadly identify three major types of doctors and patients
with peculiar characteristics, based on their "behavioral pH".
Doctor variants and their personality traits:
Type 1 (Highly acidic): Over-anxious, hyperactive, over-concerned;
talkative, tries to give more information (than what the patient can
comprehend!); over-indulgent, always thinking about the rarest and worst
possible diagnosis and complications; over suspicious, complicates the
simplest things; and highly tech-savvy. Type 2 (Balanced/Neutral – ‘Rare
species’): Takes patient’s complaints in the right perspective;
optimistic, matter of fact, balanced personality; does the things which
are just needed in the correct proportion; well informed. Type 3 (Highly
alkaline/Inert): Least bothered, carefree and happy-go-lucky
personality; does not read often and does not keep himself updated with
current knowledge; is least worried if confronted by patients;
‘autistic’ with poor eye contact with patients.
Patient variants and their personality traits:
Type 1 (Highly acidic): Over-anxious, over-smart, over-inquisitive,
talkative; voracious reader (updated with the latest developments which
the doctor most probably does not know!); impatient, aggressive, very
suspicious; pessimistic approach, always considers the worst possible
outcome; oversensitive, obsessive behavior; unsatisfied and does doctor
shopping, even goes to the extent of bullying his doctor. Type 2
(Balanced/Neutral – Rare species): Calm, composed, patient,
understanding, trusts the doctor, follows doctor’s instructions
carefully, obedient, and well behaved. Type 3 (Highly alkaline/Inert):
Least concerned, expressionless, non-inquisitive, flat affect with
The outcome of such interaction between these
reactive groups can be best left to one’s imagination. Having recently
attended ‘PALS’ (pediatric advanced life support) course with a detailed
session on cardiac arrhythmias, we could not have thought of a better
way to compare such doctor-patient interactions, than to compare them
with various cardiac rhythm disturbances with doctor acting as a
pacemaker and patient as a cardiac muscle (Table I). The
eventual outcome of their interaction (in terms of patient and doctor
satisfaction) could be then compared with the ultimate cardiac output.
TABLE I Nature and Outcome of Doctor-Patient Interaction Based on Their Personality Traits
Doctor/ Patient variant
Type of doctor-patient electro-cardiographic rhythm
Type 1/Type 1
Chaotic clinic scenario with lots of fireworks, highly
ineffective communication with neither agreeing to each other’s
inputs (ineffective cardiac output).
Type 1/Type 2
Inherently ‘hyper’ doctor is effectively managed by synchronized
cardioversion by a sensible patient.
Type 1/Type 3
Pulseless electrical activity
Doctor is left furious and confused by the indifferent patient
(no palpable ‘patient understanding’– no palpable pulse).
Type 2/Type 1
Over smart patient tries to bully a sensible doctor with
potential to flare up the situation.
Type 2/Type 2
Ideal situation with adequate patient benefit and doctor
satisfaction (adequate cardiac output).
Type 2/Type 3
Patient is receptive to only a fraction of the impulses sent by
his doctor with low overall cardiac activity.
Type 3/Type 1
Doctor and patient firing at their own rate with no concordance
amongst them with compromise in effective cardiac output.
Type 3/Type 2
Near ideal situation but tending towards inadequate cardiac
output in stressful situations.
Type 3/Type 3
Complete inactivity on doctor’s as well as patient’s part
leading to cardiac arrest (absolute lack of any effective
We are sure, by now, each of you is imaging where
he/she fits in recalling your personal experiences (I have figured out
where I fit!). However, this needs serious consideration; and given the
huge demand on part of doctors to deliver effectively, we need to be
aware and modify our personality as per the patient’s requirements, if
we are to succeed in effectively convincing our patients. This
understanding should then enable us to manage most of the stressful
Thus, we know that doctor and patient interaction
frequently results in adverse doctor/patient outcome in terms of
emotional outbursts and lot of heartburn. Careful titration of our
acidic or alkaline personalities to suit the patient’s personality is
warranted. This is important to ensure a ‘safe’ chemical reaction
between these two reactive species and to ensure a ‘sinus emotional
rhythm with adequate systemic perfusion.’ Pre-emptive bilateral
personality (pH) assessment and appropriate modulation is highly
recommended – prior to such encounters – to avoid an untoward situation.