How much should doctors reveal about themselves to patients?

How much should doctors reveal about themselves to patients?

Whether or not “self-disclosure” is an effective communication strategy in the doctor-patient relationship has been debated.  In fact, some studies have demonstrated that doctors who talk about themselves more are rated more poorly by patients than those who are more private. This topic has been of interest to me and I have written about it in my blog:  Doctor, Patient, Friend:  Blurring the Boundaries,  and explored it further in a recent book chapter in Social Media in Medicine.

In the case of teachers and students, communication strategies that promote “immediacy” have been found to have positive results in terms of promoting learning by creating a more open classroom environment.  Humor and self-disclosure are two strategies that promote immediacy. But, are these communication strategies effective in medicine also? I hypothesize that they are.

Recently a patient visited me to follow up after an ER visit. While she was in the office I recounted to her a personal tidbit that related to her day in the ER.  While she and I were on the phone and as I was advising her the preceding Saturday afternoon, I had walked outside of a local sub-shop, Dave’s Cosmic Subs, seeking out private place to talk. On doing so, I had stepped beneath a tree into a pile of fire ants and was bitten all over my feet, which caused a degree of distraction.   For this reason I ended the phone call somewhat abruptly and later called her back. Was this self-disclosure helpful? She found it amusing, but we didn’t lose much time over the conversation.   A few days later she made mention of it again as we chuckled together about life’s annoyances.

In another recent conversation with a patient who was considering various hormonal options for peri-menopausal symptoms I revealed my personal experience with using a Mirena IUD.  Several weeks later she decided this might be a good option for her as well.

Were these personal self-disclosures to my patients helpful or harmful? In the role of patient, I’ve been to see physicians who recount personal stories during an office visit that seem to take time away from my talk-time.   In a dentist’s office this can provide pleasant distraction as one is held captive with her mouth open, but in a doctor’s office it can be annoying to a patient when one knows that time is limited.

Nonetheless, physicians, with their expert knowledge of medicine, process medical information in the context of their own lives in ways that are sometimes helpful to patients to learn about by way of example.

I have, on more than one occasion, shared the story: when I turned forty I was diagnosed with hypertension.  Three months after stopping oral contraceptive pills my blood pressure normalized.  I suspect that I will eventually need blood pressure medication, in light of my strong family history and current readings (130s/80s), and also despite my normal BMI and daily exercise. However, I will try to stave it off for a few more years. Are these tidbits of personal experience helpful for me to share with my patients?

As physicians increasingly engage in social media the question of appropriate self-disclosures becomes more relevant.  Should a doctor “friend” a patient on Facebook? How should a physician conduct his or herself on Twitter?  Self-disclosure is the norm for much participation in social media. The AMA has published guidelines for social media use by medical professionals.  My own theory is that physician self-disclosure can help promote intimacy and trust between doctor and patient—qualities that are increasingly lacking in the patient-physician relationship.  I might point out that in the case of social media, self- disclosures do not occur in the context of office visits, and as such are extra communications that don’t take time away from a patient’s precious appointment time.

Recently I was interested to read about a series of studies published in the Proceedings of the National Academy of Science. The studies, led by Harvard psychology researchers Diana I. Tamir and Jason P. Mitchell, made the relatively intuitive discovery: humans get a biochemical buzz from self-disclosure.  By inference, perhaps doctors who share more with their patients are happier with their patient interactions than those who are more reserved, and perhaps those positive feelings translate into a more effective health care experience.   No one knows, and more study is needed to uncover exactly what forms of physician self-disclosure are helpful to patients and what forms are more self-serving, or “narcissistic,” detracting from the patient-physician relationship.

Juliet K. Mavromatis is an internal medicine physician who blogs at Dr Dialogue.

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  • Jonathan Marcus

    I’m a physician from Toronto. One basic rule I use about self-disclosure is this…Is revealing this information in the patient’s interest? If so, then I think it’s almost always okay to reveal.

    Sometimes I tell patients other things about my life that have nothing to do with their health concerns. I make sure that there is the time, it’s not taking away from their healthcare time and I constantly assess whether they seem interested. I make sure that the interaction is two-way and am constantly using social intuition to assess whether they are into the conversation. Humour is often involved.

    I find that some self-revealing, appropriately done, can make the environment more relaxed, humanize me and lead to a better overall connection with patients over time. Having patients feel they ‘know’ me has been gold for my long-term doctor-patient relationships.

  • Chrys

    I agree with Jonathan’s methods of self disclosure. I think it is important for the patient to see their doctors as fellow human beings. It’s easier to trust someone if you know a little bit more about them. Where I feel it would be inappropriate, is if you are disclosing something to the patient, that then burdens that patient. If you feel a need to do this, it’s time to stop yourself and seek someone you can trust, to talk to. It’s easy to become familiar with your patients over the years, and we all know there are some that are a delight to see on the schedule, maybe even, they are viewed as a break in your day. As long as you are sharing, but not burdening, I think it is a wonderful way to nurture the bond between doctor and patient.

    • Kristy Sokoloski

      I have to agree. Especially with the last sentence. Because when that bond is nutured in the right way the trust and confindence that the patient has in their doctor will only get stronger over time.

  • Dike Drummond MD

    Thanks for posting this Dr. Mavromatis. I agree with Jonathan’s comment below. There is a HUGE difference between “doctors who talk about themselves” and the kind of empathetic human interactions that can occur between the doctor and their patient.

    IMHO, there is never a bad time to “self-disclose” if the story you are about to tell is in service to the patient — it helps them see their condition from a new viewpoint or humanizes YOU so that they see that we all struggle in similar ways.

    Part of the stress of being a doctor is having been taught that emotions and becoming close to your patients is a bad thing to be avoided at all costs … even “unprofessional”. That professional bias is not healthy or even true – no matter how many episodes of “Doc Martin” you may have watched. You can feel and disclose and share and tell stories and it can be a joyful part of your practice … as long as it is in service to your patient.

    My two cents,

    Dike Drummond MD

  • Jody

    Just stay away from “this is what I tell my own children” this person I call Dr God, age 39 actually said that to me, age 55. That along with other disrespectful and demeaning behavior has me looking for a new doc.
    Recovering from the cellulitis in my replaced knee, the very thing I had said I was concerned about developing and he blew me off, saying that would never happen. Thankfully my Ortho surgeon has been caring for me through this nightmare.
    So long Dr God!

  • Dorothy Snyder

    It depends on the patient and the doctor and what is being shared if it is a good idea. Also, I think that doctors need to keep in mind that they may be wealthier than than patient, so complaining about the weather on your cruise during your vacation may not be a good idea to someone that can’t afford to take any vacations. They better think about what they choose to share.

  • Laura Helfman

    Have throughout my career have other providers feel it inappropriate to share anything, but I have found it very useful to briefly mention personal experiences when pertinent. If done correctly, it shows humility and humanity

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