Patient doctor relationship: Self Disclosure


An example of disclosure is written in a comment on a recent post by Vicarious Therapy (see comments on empathy). Her pdoc tells her he has Multiple Sclerosis. Apparently the pdoc figured that in this treatment on this moment disclosing his illness was appropriate. Several apparent reasons might contribute to the disclosure. MS has an unpredictable course, symptoms might become visible, his patient was worried.
Another example was from a GP, talking to a patient. The patient was asking how he was doing. The GP disclosed his concerns about his son suffering from Hodgkin Lymphoma. The patient comes up with a certain nutrient he always gave his children who were never ill. Talks about the good health of his family all due to the use of this nutrient leaving the GP in a state of restrained rage.The GP feels neglected by the remarks of his patient, not been given any consolation what so ever.

What is self disclosure?
Physician self disclosure is when the physician shares personal information and/or professional experiences. Personal experience includes statements about the physician’s own family members, living situation, health problems, travel experience, feelings, and political beliefs. Professional experience includes statements about the physician’s practice conditions and interactions with other health care professionals or patients.

The most common mistake in using self disclosure is that the self disclosure is focused more on the physician’s than the patient’s needs. That is also the difference in the two examples above.
Longer disclosures interrupt the flow of information exchange and expended valuable patient time in the typically time pressured primary care visit.

Sharing strong beliefs or emotions without understanding the patient’s perspective seems risky; a practitioner may unknowingly infuse the dialogue with his or her needs without carefully tying them to the patients’ needs

Other pitfalls in self disclosure e.g when the physician discloses he also has that illness might run the risk of premature reassurance or advice without fully understanding the patient’s experience.This can paradoxically raise patient anxiety. It may also increase the chance of a misdiagnosis if the physician does not distinguish the patient’s clinical situation from his or her own.

In a recent published descriptive study using sequence analysis of transcripts of 113 unannounced, undetected, standardized patient visits to primary care physicians, the authors came to the following conclusion:

There was no evidence of positive effect of physician self disclosure; some appeared disruptive. Primary care physicians should consider when self-disclosing whether other behaviors such as empathy might accomplish their goals more effectively. There are other ways in showing your human side such as with consolation, empathy, compassion and understanding.

Now I am not saying self disclosure is inappropriate. There is always some kind of self disclosure, the photo’s on your desk, the way you dress etc. The most important thing about self disclosure is as little as possible. The next question with self disclosure is how much and always to the benefit of the patient, not the doctor.

What do you think about self disclosure, let me know in the comments

The next post in this series will be next week Wednesday July 30th.

Related posts on this blog in this series:
Can we teach empathy
Consolation reduces stress
MacDaniel, S.H. (2007). Physician Self-disclosure in Primary Care Visits. Archives of Internal Medicine, 167, 1321-1326.