The University of Akron
From 1999-2009, I had the opportunity to teach an online course in counseling for audiologists earning an AuD through the Central Michigan University/Bill Wilkerson Center Vanderbilt University distance education program. It seems hard to believe now, but when the AuD program started, many enrollees had little experience with email, so to get the ball rolling, the first assignment was to complete the Keirsey temperament questionnaire and email me the results (Rational, Artisan, Idealist, or Guardian). My goal was two-fold: (1) to jump-start the “know thyself” reflection process and (2) to help students become familiar with my email address. I wasn’t looking for any trends, but … take a look:
Ten years and 25 semesters later, with results from 390 audiologists (all with MA degrees and an average of 15 years experience), the summative data show a very strong tendency toward Guardian temperaments (82% in the middle bar, compared to 40% in the general population on the left). Since then, I have posed the same assignment to AuD graduate students (from 2008 to 2014, right hand bar), and have also frequently asked attendees at workshops to spend 10 minutes on this exercise, with very similar results. For instance, among 27 practitioners in a recent workshop, our results were 0% Rationals, 15% Artisans, 15% Idealists, and 70% Guardians.
"Knowing Thyself" Stimulated Change
Of course, this exercise does not represent rigorous science, but it does give us food for thought. We would expect certain temperaments to be drawn to some professions more than others. For information on each temperament, visit the Keirsey website; specific to our topic, we learn that Guardians:
- Are given to service and preserving social institutions
- Have a natural talent in managing goods and services
- Keep things running smoothly in families, communities, schools, churches, hospitals, businesses
- Take pride in being dependable and trustworthy
- Believe in law and order… honoring customs and traditions … following the rules and cooperating with others…
- Are meticulous about schedules and have a sharp eye for proper procedures
The four Keirsey Temperaments are aligned with Myers-Briggs results in the table above. A Guardian can be further categorized as Supervisor, Inspector, Provider, or Protector: in other words, someone who assumes responsibility for people and things.
At first I took these results with the proverbial grain of salt, but an intriguing pattern kept occurring. By mid-semester, the distance learners would begin to wonder if their "Guardian natures" interfered with patient counseling. They generally agreed that the Guardian characteristics matched their self-perceptions, but in the context of audiology, perhaps being someone who "assumes responsibility of people and things" was actually a problem.
The question that generated the most discussion was a simple one: “Who owns this hearing loss?” Distance learners (“don't worry, I'll take care of everything") wanted the answer to be “the audiologist owns the hearing loss” by virtue of education and expertise. This premise is probably not unusual: Palmer (1998) contends that "Virtually all professionals have been deformed by the myth that we serve our clients best by taking up all the space with our hard-won omniscience" (p. 132).
But subsequent discussions about patient autonomy and the difference between compliance and adherence challenged assumptions of ownership. If we have been "deformed by the myth" that we own hearing loss, then we effectively assume all responsibility to help, putting the patient in a passive role. However, we have enough experience and evidence to know that this approach is ineffective. Patients, of course, own their hearing loss, and improving their situation ultimately depends on their decisions, not ours. It does seem likely that the Guardian temperament can assume too much responsibility and in fact interfere with patient outcomes.
Thus challenged, Guardians bravely explored patient trust, the evidence relating communication styles to patient outcomes (Zolnierek & DiMatteo, 2009), shared decision-making, and health care partnerships – none of which require a Supervisor, Inspector, Provider, or Protector! Their willingness to step out of their comfort zones and test out new ways to "be" with their patients spoke volumes.
… in audiology is not the otoscope; it's the person holding the otoscope (you/me/us). In a typically hectic day, it can be easy to forget this maxim of health care: “The most therapeutic instrument is the self” (Charon, 2001, p. 1899). All instruments require regular calibration, and we are no exception: we must routinely monitor our assumptions, the impact of our words and body language, our presence in the room, our willingess to share ownership (and its implied power) of a patient's problems. We do bring training and experience to each patient encounter, but we also bring OURSELVES: our temperament as well our commitment and values. From these intangibles, patients decide whether we are worthy of their trust.
Charon, R. (2001). Narrative medicine: A model of empathy, reflection, profession and trust. JAMA, 286(15), 1897-1902.
Palmer, P. J. (1998). The courage to teach. San Francisco: Jossey-Bass.
Zolnierek, K.B., & DiMatteo, M.R. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47, 826–834.