Figure 1
A Circumplex adapted from Wiggins 1982, visualization of four prototypical patient profiles aligned with the extremes of the underlying scale. Pictures of Patients were AI-generated using GPT-5 B Illustration of continuing state changes depending on conversation.
Table 1
Exemplary overview of General Communication and Challenges, Identifying the Problem, and Compliance for the four different basic state combinations.
| GENERAL COMMUNICATION AND CHALLENGES | ||
|---|---|---|
| SP PERSONALITY COMBINATION | COMMUNICATION | PROFESSIONAL CHALLENGE |
| Agency high, Communion high (dominant & friendly) | Open, cooperative, but with clear expectations and straight communication | Maintain a balance between participation and medical guidance – do not allow yourself to be overruled by the “friendly expert” in the patient |
| Agency high, Communion low (dominant & cold/confrontative) | Directive, critical, suspicious, possibly aggressive | Conversations can quickly become confrontational; high risk of resistance or escalation |
| Agency low, Communion high (submissive & friendly) | Calm, polite, avoids confrontation, rarely addresses problems on his own initiative | Conversation seems harmonious, but there is a risk of false compliance; important issues remain unsaid |
| Agency low, Communion low (passive & cold) | Short-tempered, defensive, reserved, deflecting | Difficult to access, high risk of conversation breakdown or avoidance of important topics |
| IDENTIFYING THE PROBLEM | ||
| COMBINATION (AGENCY/COMMUNION) | COMMUNICATION PATH | PROFESSIONAL NEEDS |
| high/high | Patient actively names symptoms, even embarrassing ones, but selectively and with a focus on solutions | Ask specific questions, verify priorities and psychological stress to identify blind spots |
| high/low | Patient selectively brings up topics, is skeptical about medical questions, avoids weaknesses | Focusing on facts and emphasizing benefits is required |
| low/high | Reveals little, but responds openly when asked; requires active exploration | Gentle, structured questioning of potential problems is necessary to uncover hidden issues (such as ED) |
| low/low | Rarely gives information voluntarily, avoids contact and openness | Laborious, requires a high degree of structure, patience, and dominant conversation steering |
| COMPLIANCE | ||
| COMBINATION (AGENCY/COMMUNION) | ASSUMED COMPLIANCE | SPECIFICS |
| high/high | High, if convinced, wants to have a say, feels responsible | Shared decision-making is crucial; clear professional communication is necessary |
| high/low | Low, questions authority, makes their own decisions | Compliance often only occurs with self-motivation – highlight personal goals |
| low/high | Moderate, happy to cooperate, but without real conviction | Often does not understand the reason, does things “because the doctor says so” – education and participation are important |
| low/low | Low – avoids, forgets, or ignores therapy | Requires structured follow-up care, continuous motivation, relationship building |
Figure 2
Screenshot of the browser-based application, showing a chat with a sample patient. Shown is the exemplary start of the conversation with Mr. P. Engel.
| AI | Artificial Intelligence |
| CIIT | Contemporary Integrative Interpersonal Theory |
| DEGAM | German Society for General Medicine and Family Medicine (German: Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin) |
| IPC | Interpersonal Circumplex |
| LLM | Large Language Models |
| PerTRAIN | Personalization Training in Medicine |
| SBL | Simulation-based learning |
| SPs | Simulated Patients |