Physician self-disclosure about illness

I recently struggled with an interesting patient care issue related to my illness. I had to cancel several weeks of clinical sessions, which I realize is a hardship for my patients.

A few weeks ago, when seeing a long-time patient of mine — a warm woman with several chronic conditions — I apologized that we had cancelled her previously scheduled appointment on short notice. I paused a beat and quietly said that I had been hospitalized. She was genuinely concerned. She was anxious to know more information and if  I was going okay. I waved it off and said that I was getting better. But as I attended to her needs I could not help thinking whether I should share more information with her.

There is a growing literature about physicians sharing personal information with their patients, something known as “physician self-disclosure” or “physician personal disclosure” In one study, investigators examining audio recordings of patient visits found that when general internists self-disclose patients report lower satisfaction, but when surgeons self-disclose patients report higher satisfaction. An accompanying editorial suggested that some forms of self-disclosure may be useful while others may violate patient-provider boundaries.

Another paper in which investigators observed physicians interacting with standardized patients concluded that there was no evidence of a positive effect of physician self-disclosure, that it could be disruptive, and that physicians should consider avoiding it. Physicians Danielle Ofri and Juliet Mavromatis explored their experiences with personal disclosures to patients in their recent blog posts.

I considered the pros and cons of disclosing details of my illness to my patient. On the one hand, I didn’t wish to violate boundaries or to have my patient worry about me. On the other hand I did not believe that boundaries were absolute and impermeable, and I was comfortable being seen as human and subject to the same frailties as all human beings. I even have patients with whom I’ve shared meals and some with whom I connect on social media. So I’m comfortable selectively breaching what some would consider to be inviolable boundaries. After all, if I practiced and lived in a small town it’s likely my patients would know almost as much about my life as I knew about theirs. It’s only the big city in which I practice that makes it less likely I will accidentally connect with patients in a non-clinical context.

As we often do in primary care, I asked myself what was the worse thing that could happen if I disclosed? After all, I had already made a conscious decision to disclose my condition to the world through my blog post. And I knew this patient for so many years — what was I afraid of?

Just before I left, I scrawled the link to my story on a pad of paper in the exam room and handed it to the patient. Later that night, I found that she left a nice comment.

Would I have done this for all my patients? I doubt it. Did I do the right thing? I think so. But I suspect my views on this will continue to evolve over time.

Let me know your thoughts.

Daniel Sands is an internal medicine physician and co-founder, Society for Participatory Medicine.  He blogs at Connecting.

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  • Ron Smith

    Hi, Daniel.

    I’m there with you, though it is not my illness. My daughter, Laura, had so many difficulties with fetal isotretinoin embryopathy over her 24 years until her death in 2012. Stacy and I cared for her ourselves at home all those years.

    I was always guarded in sharing about her until recent years and then only to certain families who also had development and other severe health problems. We physicians tend to deal with our pain in silence.

    Since age 13, I’ve ridden motorcycles as well. In Arkansas, where I grew up, you couldn’t get a license to drive a car until 16, and lots of kids rode to school that way. I have two big hogs today and I’m a careful and experienced rider.

    I have had one mother tell me to please be careful. She was worried. It was genuine caring concern about both my own safety and the warmth of their satisfaction in and appreciation of my practice.

    Physicians are a strange crew. Our information is exceedingly public due to state licensing requirements and in many ways our life is not our own. I have always felt my need for privacy close to all the other needs of life.

    I sometimes wish patients and parents could really realize just how tightly we are corralled by our profession. We are pressed by the ever-increasing certification requirements, the business side of medicine from which we must make a profit to support our staff who depend on us, and the medicine with which we treat our patients to the best of our ability.

    Somewhere in there is our own life, hopes, dreams, failures, disappointments, hurts, challenges, and longings.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • DoubtfulGuest

    I wish you the best of health, Dr. Sands. We patients have independent minds, and she might have worried about you more afterward if you hadn’t answered her question. :) I care about my doctors and want to know what’s going on with them, at least a little. I find it weird to share my own personal information with someone who’s a black box, even though the reason for my doing so is for my own medical care. That said, I support doctors’ rights to privacy, and patients’ rights to be taken care of by someone who behaves professionally. It’s a fine line. My own experience and what I’ve heard from other people, is that the main conflict with physicians’ self-disclosures is the time constraints. Are the patient’s medical concerns still addressed during the visit? You gave her a link to your story, which didn’t take but a moment. She could then choose how much to read and how much to think about it afterward. I wouldn’t have a problem with it.

  • Frank Lehman

    So he ” made a conscious decision to disclose (his) condition to the world through (his) blog post” and now he has to go thru such a mental exercise to decide whether he should tell someone the same thing he has told everyone else. He really needs to get a life.

  • John C. Key MD

    Can’t imagine why this is an issue at all unless it is abused by either party. At my age I’ve had and survived so many different illnesses I find it quite useful to share my experiences and personal knowledge. I find this to be helpful to patients and have yet to see it backfire.

  • Kristy Sokoloski

    Dr. Sands,

    I think that you did the right thing. I feel that having a bit of the human side come in to the conversation even though it’s business related: treating and managing medical conditions can sometimes help that bond between physician and patient be stronger. Like one of the other posters said I do want to know a little bit about what is going on in my doctors’ lives if they are willing because I know that they are still human just like me. They have pressures at home that can affect them even on the job even though they try not to let that happen. So yes, from time to time I will ask them how they are feeling or about other things going on in their life.

  • Rginsberg2

    I lean toward disclosure. Seems to be very beneficial when information is offered selectively, to enhance issues related to the specific patient. Then, disclosure helps to illustrate points directly related to the patient’s health. — We are all human, doctor and patient. Ethical practice is vital. Denial of our human bond is destructive, tho.

  • rbthe4th2

    Thank you for your honesty and respect of the patient Dr. Sands. May you have a safe and healthy 2014 and beyond.

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