Acorn doesn't fall too far from the tree

Genes doom driven radiologist's daughter to life of impatience and the trouble it brings

We should take care not to make the intellect our god; it has, of course, powerful muscles, but no personality." -Albert Einstein

"Personality is the entire mental organization of a human being at any stage of his development. It embraces every phase of human character: intellect, temperament, skill, morality, and every attitude that has been built up in the course of one's life." -Warren HC, Carmichael L. Elements of human psychology. Rev. ed. Boston: Houghton Mifflin, 1930:333

It all started when my 13-year-old daughter had another meltdown.

"It's all your fault, Dad," she screamed.

My response was what any good-natured, beaten-down father would say.

"What did I do now?"

"I got into trouble today because of my impatience, and I got it from you."

As I pondered this, I began to think about the power of genetics and self-determination, and what defines the essence of our very being.

The next day at work, as I was garbaging through an endless stack of portable chest radiographs, my mind returned to my daughter's words. Maybe it was my fault after all. My daughter had indeed inherited my deficient genes (my wife says she did the best she could with what little she had to work with) and had been schooled in the fast-paced habits of my sprinting tendencies. Why expect her not to be impatient?

But is impatience necessarily a character flaw? It is the fuel that drives me through another busy, stressed-out, and technically challenging day. My impatient, extreme goal-oriented behavior could be the most important attribute to explain my work-related productivity. If only I could figure out how to turn it on and off at appropriate times, I would be the master of my own personality.

I began to think about the relationship between personality and work performance. Was I an outlier among my radiology colleagues, or was my personality emblematic of an ever-changing, technology-driven field that has dramatically transformed itself in the past decade? Perhaps the only real way to answer this question was to survey the radiology community and scientifically analyze what common personality traits appear and what features make some radiologists better adapted than others.

With the help of Diagnostic Imaging, we placed a survey online and sought out volunteers within the readership to share their experiences as they relate to population demographics, work experience, personality, and perceived stress. To date, we have received 270 completed surveys, and the results are fascinating. We look forward to expanding the data collection and sharing our collective knowledge with the community, in the hopes of better understanding the interaction of personality, stress, technology, and work experience.

One of the most widely accepted theories of personality is the "Big Five" taxonomy developed by Goldberg.1,2 This describes five basic dimensions, or factors, that define personality:

- neuroticism (emotional stability);

- extroversion (social adaptability);

- agreeableness (compatibility with others);

- conscientiousness (consideration for others); and

- openness (adjustability to new ideas and experiences).

Neuroticism (N) is the most pervasive domain of personality and assesses both emotional stability and susceptibility to psychological distress. Because disruptive emotions interfere with adaptation, high N individuals are prone to higher degrees of irrationality, stress, and poor impulse control. This has profound significance for the current practice environment, in which radiologists must deal with rising workload, increasingly large and complex data sets, and ever-changing technologies.

Extraversion (E) is a measure of sociability. High E scores are typically seen in cheerful people who enjoy personal interaction, large groups, and stimulating activity. Low E scorers (i.e., introverts) tend to be more reserved and independent and to work alone. It is historically interesting to relate extraversion to the design and layout of radiology departments. In a film-based department, technologist work spaces and radiologist reading rooms were traditionally wide open areas that accommodated social interaction, consultation, and continuous dialogue. With the transition to filmless operation, technologists and radiologists tend to work more in isolation, partly in response to productivity and workflow optimization demands. Studies have shown that physician consultations dramatically decrease with the advent of PACS, due to the ability of referring clinicians to access images and reports without traveling to the imaging department.3 Technology development and innovation may have lessened the impact of high E scores on the current generation of practicing radiologists.

Agreeableness (A) is a dimension of interpersonal tendencies, with high A scores associated with altruism, sympathy, and cooperation. Low A score individuals tend to be antagonistic in nature, skeptical of others' intentions, and competitive rather than cooperative. It is important to realize that agreeableness is not always a virtue, and readiness to fight or defend one's own interests can be advantageous. In today's practice environment, radiologists are faced with heightened malpractice risk, decreasing reimbursements, and turf battles with their clinical colleagues. At the same time, skeptical and critical thinking contributes to accurate analysis, which is crucial in scientific research and decision-making. Individuals with low A scores may be best suited to address these challenges, thereby serving an important role.

Conscientiousness (C) is often associated with academic and occupational achievement. High C individuals are purposeful, strong-willed, and determined, and they are described as possessing the will to succeed. Unfortunately, these same people can also demonstrate fastidiousness, compulsive behavior, and workaholic tendencies. This illustrates the dichotomy of personality factor scores, in that both positive and negative attributes can be observed, often in specific contexts. In the medical field, goal-oriented behavior is commonly viewed in a positive light, for it drives the individual to overcome the stresses and challenges of medical school, residency, and professional life.

Openness (O) is especially relevant to the ever-changing world in which we live and work. High O score individuals tend to be curious about both inner and outer worlds, and their lives are experientially richer than their low O score counterparts. High O scorers tend to entertain novel ideas and unconventional values, experiencing both positive and negative emotions to a greater degree than closed individuals. Adaptability to change and innovation has become a necessary prerequisite for the modern-day radiologist. In the last decade alone, new imaging and information technologies have transformed the way imaging data are acquired, archived, displayed, interpreted, and reported. If new and emerging technologies are to be successfully developed and implemented, this process will require the collective openness of the radiology community.

These Big Five personality factors have been shown to be universal in nature,4 stable throughout adult life,5 and the result of a strong genetic predisposition.6 Using this knowledge and scientific foundation, we selected the NEO Personality Inventory,7,8 which was developed to operationalize this model of personality. The survey data reported were the composite result of 270 online responses from radiologists (which does to some extent skew the respondent population by excluding non-Internet users). A few highlights of the data reflect job satisfaction, technology, and stress:

- Job satisfaction. With all the heightened economic, medicolegal, and professional challenges radiologists face, it is no surprise that many are frustrated and dissatisfied with their jobs. While this sentiment is undoubtedly multifactorial, one surprising observation is the direct correlation observed among survey respondents between personality and job satisfaction. Of the Big Five personality factors, three were shown to have statistically significant correlation with reported job satisfaction: neuroticism, extraversion, and agreeableness. Extraversion and agreeableness demonstrated a positive correlation with job satisfaction, while neuroticism had a negative one. These data do not imply that all high N score radiologists are dissatisfied with their jobs, but they do give scientific credence to the well-known fact that emotional stability and job satisfaction often go hand in hand.

- Technology. This is the proverbial double-edged sword of the radiology community. On one hand, it is our lifeline, while on the other, it can be the bane of our existence. Radiology is the only medical specialty that is 100% technology-dependent. Preliminary analysis of survey results suggests that personality and technology are related, and, not surprisingly, the most important personality factor defining this relationship is openness. Additional investigation of this fascinating subject will specifically seek to identify how technology can become more adaptive to different personality types.

- Stress. This was assessed in the survey in two separate ways. Survey respondents were first asked to subjectively rate their degree of perceived occupational stress. Second, the survey included the 14-item Perceived Stress Scale (PSS),9 a Likert-type rating scale that was developed to quantify the psychological construct of perceived stress.

In both instances, respondents overwhelmingly reported a strong positive correlation between neuroticism and stress and a strong negative correlation between agreeableness and stress. Extraversion was also shown to have a negative correlation with stress, but to a far lesser degree than neuroticism. The data raise as many questions as they answer, and additional research is required to better delineate the complex relationship between personality and stress. For the practicing radiologist, several important and timely questions arise:

- Can personality be modified to reduce stress?

- What role can technology play in reducing stress (e.g., affective computing)?

- How can the physical environment be modified according to specific personality profiles to reduce stress?

- What cumulative role does personality play in predicting job burnout?

- What role does personality play in overall job performance?

While additional work is planned to investigate these complex relationships, the data already suggest potential long-term ramifications. If personality does indeed play an important role in predicting job satisfaction, stress, and technology avidity, should pre-employment and preresidency personality profiling be performed on a regular basis? In the current business climate, this is being done on a regular basis, with approximately 30% of employers using some version of personality testing in hiring.10 Eighty-nine of the Fortune 100 companies report using the Myers-Briggs personality test in hiring and promoting. The whole science of personality profiling creates both an interesting opportunity and a dilemma for the radiology community as it strives to address increasing levels of stress. As for me and my high N score, my life would have in all likelihood dramatically changed if personality profiling had been a commonplace event in my earlier years. I would not have been accepted into a radiology residency and would not have been deemed an acceptable spouse by my loving wife. While the acorn may not fall far from the tree, I haven't yet decided if that is a good or bad thing.

All interested radiologists are encouraged to go to the site http://www.zoomerang.com/survey.zgi?p=WEB225C5CHHWWN and participate in the survey.

Dr. Reiner is director of radiology research at the VA Maryland Health Care System in Baltimore. Dr. Eliot Siegel contributed substantially to this article and is vice chair of diagnostic radiology at the University of Maryland School of Medicine and chief of radiology and nuclear medicine at the VA Maryland Health Care System.

References

1. Goldberg LR. Standard markers of the Big Five factor structure. Unpublished report. Oregon Research Institute, 1990.

2. Saucier G, Goldberg LR. What is beyond the Big Five? J Pers 1998;66:495-524.

3. Reiner B, Siegel E, Protopapas Z, et al. Impact of filmless radiology on the frequency of clinician consultations with radiologists. AJR 1999;173:1169-1172.

4. McCrae RR, Costa PT Jr. Personality trait structure as a human universal. Am Psychol 1997;52:509-516.

5. Soldz S, Vaillant GE. The Big Five personality traits and the life course: A 45-year longitudinal study. J Res Pers 1999;33:208-232.

6. Jang KL, McCrae RR, Angleitner A, et al. Heritability of facet-level traits in a cross-cultural twin sample: Support for a hierarchical model of personality. J Pers Soc Psychol 1998;74:1556-1565.

7. Costa PT Jr, McCrae RR. Normal personality assessment in clinical practice: The NEO Personality Inventory. Psychol Assess 1992;4:5-13.

8. http://www3.parinc.com

9. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385-396.

10. Cullen LT. Sats for jobs. Time April 2, 2006:89.