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.