Wednesday, November 16, 2005

Myers-Briggs & ICU end of life decisions

Anaesthesia has an interesting and somewhat unusual article about end of life decision making in the ICU and Myers-Briggs personality typing. It looks at several years of a single ICU's practice of limiting/withdrawing life sustaining care prior to death, and analyzes the frequency of those decisions by attending physician, and by the attending physician's Myers-Briggs personality type (yes, I am embracing Christian's use of Wikipedia). The study is unfortunately limited by a whole series of assumptions that the authors made to determine, given how often the attendings worked, what percent of the treatment limiting decisions they should have each made (assuming there was no variation between attendings). Much of what they found is not surprising: ~80% of ICU deaths were made after a decision to limit life-sustaining care in some way & there was a wide variation amongst physicians regarding the frequency of being involved with treatment limiting decisions. What they then did was to administer the MB to the docs & they found that those who were disproportionately involved with treatment limiting decisions clustered towards the 'judging' end of the judging/perceiving domain.

Wikipedia on judging types:
J[udging]-types tend to prefer a step-by-step (left brain: parts to whole) approach to life, relying on external rules and procedures, and prefering quick closure...

& the authors of the article:
These individuals prefer a clear idea of what is expected, communication that is clear and concise, and decisions to be made quickely, clearly and finally.

What all this means is entirely unclear. However, it is refreshing to consider that the wide inter-personal variability amongst physicians regarding a willingness to broach the withdrawing of life-sustaining care in dying patients has a measure of predictability. On the other hand it's very possible that this clustering on the MB is catching a completely different phenomena not measured by the authors (place of origin, social class, type of medical training [pulmonary vs. anesthesia], age/experience, religiousity, who knows...). I'm just glad the authors asked.

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