Staff Management

4 Personality Tendencies to Understand to Better Train Staff & Better Serve Patients

Dr. Stewart’s staff working with a vendor rep to get trained on a new medical eyecare product. Dr. Stewart says that an understanding of how different personality types respond to the expectations of others makes a difference to how well employees are managed and patients are served.

By Jennifer L. Stewart, OD

Sept. 28, 2022

We all have different personality tendencies that influence how we interact with others. Understanding these personality differences, and their impact on how we relate to co-workers and patients, can change the trajectory of your practice. Here are details on the book that educated me about these personality differences, and how to keep these varying personality tendencies in mind when delivering staff training and working with patients.

People Respond to Expectations Differently
“The Four Tendencies” by Gretchen Rubin is based on the concept that people respond to expectations differently, depending on their personality tendencies.

Understanding how people respond to expectations can help you better communicate with them, manage them and help them be more effective. We have both outer expectations (work deadline, meeting a friend) and inner expectations (starting a diet or a new exercise routine). We all handle these expectations differently, and understanding how each person on your staff does this can lead to a breakthrough in team cohesiveness. Also, understanding these differences when dealing with patients can lead to increased compliance and better exam-room communication.

4 Tendencies as Seen in You & Your Staff
Upholders: (me!)
Upholders meet both internal and external obligations/expectations willingly. They follow directions, complete work on task, show up on time and love having a “to-do” list. If you ask them to do something, you can rest easy knowing it will be done on time, every time. They love rules, boundaries and goals. They are punctual and reliable. However, they can be inflexible and can come across as cold or judgmental, and don’t always have tolerance for other employees.

Questioners want to investigate everything. They want to know WHY they should do something, so they can meet and follow through with their inner expectations. They will not follow processes and procedures without first understanding and questioning the reasoning behind them. They can quickly derail a staff meeting by asking a million questions. It is easy to dismiss them by telling them, “It has always been done this way, so do it!”

However, when these employees are given evidence to back up a statement, they are more likely to follow directions and be extremely dedicated and hardworking. Understanding that they need specific answers to their questions, and that they are not trying to be difficult, can be helpful when managing these employees.

Obligers are great team players. They live to please and don’t like to let anyone down. They will make sure everyone is supported and taken care of. While they excel at meeting external obligations, they can struggle with meeting internal obligations. They require more supervision, and can often seem to lack initiative or not be seen as “self starters.” They often need more support and structure, but will work hard with proper guidance to meet the needs of the team.

Rebels want to do what they want, how they want to, when they want to. They respond poorly to self-expectations, such as routines and rules, and chafe at the thought of reminders, micromanaging and supervision. How do we properly support and manage rebel staff members?

Rebels can often come across as rude or difficult to manage, but can be super-creative and think outside the box. Their actions are not a personal or professional retaliation. It’s just that they are motivated differently. When given more freedom, but still clear guidelines, they are likely to be more compliant. They need the balance of supervision without feeling constrained, and can be a huge asset in an office because of their way of thinking.

4 Tendencies as Seen in Your Patients
Upholder patients are rule-followers. They take their drops as directed, they replace their contact lenses properly and never miss an appointment. They love to be pre-appointed, and follow all recommendations from doctors. They know how to meet both external expectations (“Dr Stewart wants me to do this, so I will) and internal obligations (“Time to take my drops right at bedtime!”)

Oh, the questioner patient! They will resist outer expectations (replace your contact lenses daily) unless given clear, specific reasons as to why they need to do this. They need to have complete understanding of everything they are being asked to do before they can make a decision and meet their inner expectations. They often ask for supporting documentation (articles, research, pamphlets, websites), so they can learn more. These patients often suffer from “analysis paralysis” as they desire too much information, which often leads to a failure to make a decision.

These patients should be shown the minimum number of frames and lenses in the optical, as they are often the patients who leave without being able to make a decision after spending two hours with an optician. They can often come across as rude, wishy-washy and as time-wasters, but their fear of making the wrong decision can lead to them making no decision at all.

These patients often present to us in the exam room with a list of questions to be answered before we even start, which can lead to us being frustrated. However, taking time to let them feel that they have the right information (not too much) to make a decision can turn these patients into our most loyal and happy patients. They are the ones who proclaim “no one has ever taken the time with me that you have!” as most of the time they are brushed off or dismissed.

Obligers want to please as patients, and do not want to disappoint. They want to be held accountable and will do as directed to fulfill their obligations to external expectations. These patients respond well to comments such as, “Mrs Jones, I will see you in six months to monitor your retinal health” versus open-ended directives such as, “call us to schedule your appointment in six months.” They are much more likely to follow precise instructions than take the time to schedule themselves. These patients may be seen as chronic no-show patients if not managed properly. These may be the patients who take six months to pick up their glasses if their dispense was not scheduled at purchase.

Rebels can be our toughest patients to deal with. They can resist pre-appointing (“how will I know where I will be in a year?”), changing their contacts (“I change them when they hurt”) or be seen as non-complaint. They won’t question why, and they won’t feel the need to please. They just often won’t do as asked. These patients need to feel that they are making their own decisions, and we often have to communicate differently with them. They like freedom of choice, and want the decision to be theirs. If we push or threaten them, they can dig in more and become even more difficult.

Appealing to their lifestyle can be a great communication strategy. Instead of telling them to do something, working together toward their goal is helpful. For example, “Mr. Smith, I know we have discussed your over-wear of contact lenses. You run the risk of infection, and even blindness. The decision to take care of your eyes is ultimately up to you.” By giving them information and letting them decide, without pushing, they will often come around.

Use Understanding of Personality Tendencies in Staff Training
Have each staff member take the quiz in the book to understand which personality type they are. Then, have a staff meeting to discuss the different personalities we all have and how we can best communicate with each other.

The book is also great for understanding how best to tackle objections from patients and how to deal with difficult people (some of whom happen to be your patients). In our office, we used what we learned about personality tendencies to do role-playing exercises and come up with best practices for managing challenging patients at the front desk, optical and in the exam room.

When the personality tendencies of doctor(s) and support staff are understood, employee satisfaction is increased. When staff feel “heard” or “understood,” they are less likely to leave and are more likely to be engaged in their jobs. There also is a better work environment when employees understand how best to communicate with each other and with patients.

Staff differences can be frustrating, but by understanding how best to work together based on our differences and similarities, we can build an amazing team. And by understanding the behaviors of patients better, we can be better prepared to communicate with them and handle objections.

Patients who feel that their needs are being met, and have a great experience in your office, will continue to return and refer other patients to the practice. Happy patients= happy staff= happy office!

Jennifer Stewart, OD, provides advisory services and consulting to the optometric community through her company, OD Perspectives. She is also the co-founder and Chief Vision Officer of Performance 20/20, a sports and performance training center. In addition, Dr. Stewart was recently named professional editor of Independent Strong. She can be reached at

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