Doctors Talking to Patients About Themselves: How Much and What?

There has been much consideration about how much a physician should talk to the patient about him/herself. More importantly beyond “how much” is the concern about “about what”. The question is whether there is an ethical and professional boundary which physicians should not cross when revealing their own lives. There appears to be evidence that some revelation is therapeutic providing some confidence to the patient that the physician and patient are working together, avoiding a patient impression of physician paternalism. There is some evidence that patients may sue physicians less often if the physician says the appropriate words about him/herself.

What do physicians reveal? From Journal of General Internal Medicine vol 19, nr.9, 2004, there is an article describing a research study on this topic titled
“What Do Physicians Tell Patients About Themselves? A Qualitative Analysis of Physician Self-Disclosure” by Mary Catherine Beach, MD, MPH; Debra Roter, DrPH; Susan Larson, MS, Wendy Levinson, MD; Daniel E. Ford, MD, MPH; Richard Frankel, PhD
The following is the abstract of the article:

Objective: Physician self-disclosure (PSD) has been alternatively described as a boundary violation or a means to foster trust and rapport with patients. We analyzed a series of physician self-disclosure statements to inform the current controversy.

Design: Qualitative analysis of all PSD statements identified using the Roter Interaction Analysis System (RIAS) during 1,265 audiotaped office visits.
Setting and Participants: One hundred twenty-four physicians and 1,265 of their patients.

Main Results: Some form of PSD occurred in 195/1,265 (15.4%) of routine office visits. In some visits, disclosure occurred more than once; thus, there were 242 PSD statements available for analysis. PSD statements fell into the following categories: reassurance (n= 71), counseling (n= 60), rapport building (n= 55), casual (n= 31), intimate (n= 14), and extended narratives (n= 11). Reassurance disclosures indicated the physician had the same experience as the patient ("I've used quite a bit of that medicine myself"). Counseling disclosures seemed intended to guide action ("I just got my flu shot"). Rapport-building disclosures were either humorous anecdotes or statements of empathy ("I know I'd be nervous, too"). Casual disclosures were short statements that had little obvious connection to the patient's condition ("I wish I could sleep sitting up"). Intimate disclosures refer to private revelations ("I cried a lot with my divorce, too") and extended narratives were extremely long and had no relation to the patient's condition.

Conclusions: Physician self-disclosure encompasses complex and varied communication behaviors. Self-disclosing statements that are self-preoccupied or intimate are rare. When debating whether physicians ought to reveal their personal experiences to patients, it is important for researchers to be more specific about the types of statements physicians should or should not make.

As I noted on a previous posting on this blog, ethicist Robert Veatch has written about the importance of the patient finding a personal physician who carries the same goals and values as the patient and perhaps also the same culture or religion. This would suggest that at some point, the physician would engage in self-disclosure to make this information available to the patient.

There is no doubt that empathy is an important tool in making a connection with the patient and his/her illness. As noted in a previous post (March 3, 2005), the words of Harry Wilmer: “Sympathy is when the physician experiences feelings as if he or she were the sufferer. Sympathy is thus shared suffering.Empathy is the feeling relationship in which the physician understands the patient's plight as if the physician were the patient. The physician identifies with the patient and at the same time maintains a distance. Empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship.”

And for empathy to be most true and not “acted”, the physician must have had some similar life-experience. Thoughtful documenting that experience to the patient can validate empathy, this more real understanding by the doctor of the patient’s concerns.

What has your doctor told you about him/herself? ..Maurice.

ADDENDUM: You may wish to also read a subsequent posting on September 19, 2005 titled
"The Charisma of the Vulnerable Human Physician: The Decline of Charismatic Authority?" which I think is related to the topic of physicians self-disclosure.