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.