Monday, January 12, 2009

Physician Self Disclosure

How much should the doctor talk about him/her self?

There have been a number of recent articles in medical journals that showed when physicians talk about themselves it can be distracting for the patient. One study showed that 40% of physician self-disclosures were unrelated to the patient's preceding remarks. In another article they found that primary care physicians talked about themselves to 30% of patients and it was not effective in conveying understanding or helping patients with improved self-care.

The only purpose of a physicians self disclosure should be if it is directly related to the patient's needs. It can be a way to facilitate understanding, increase rapport and relationship, or educate.
The Annals of Internal Medicine discussed ways physicians can reveal themselves to patients that would be in the patient's best interest.

Here are some examples:
Right: "So you have a new baby! I remember that time so well. How is that going for you?"
Wrong: "I was so bored when I stayed home with my newborn."

Right: "I understand that you are nervous about the colonoscopy. I know from experience that they sedate you well and use medications that take away the anxiety. Tell me what concerns you?"
"I had a colonoscopy and I breezed through it. I was nervous, however, when they told me they removed a polyp but I felt better knowing I had it done and it ended up being benign so it all ended well."

Right: "I know how frightening your mother's diagnosis of Parkinsons is. Here is a website with more information and resources the family can tap into.
Wrong: " My mother was diagnosed with Parkinsons and it was such a strain for my father and the entire family. It worked out well to have a son as a doctor because I was able to intervene and get them the help they needed. I got her to the best specialist and she's on good medication now that I help manage."

If sharing pieces of your own life can improve the patient experience or education, self disclosure can break down walls and be a help in the relationship. Too much disclosure that isn't patient focused might just be self indulgent for the doctor. What do you think?


Anonymous said...

From experiancing a primary care doctor that most of the time has done that I think it can help, except one time that it got off on to a new continuing educationing she had just taken caused what blood tests I should have ordered to run out of time for discussing

Anonymous said...
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Anonymous said...

Martin we are not talking about viagra or impotency here as well as this is not be a place to advertise.

Steven Reidbord MD said...

We pay a lot of attention to this issue in psychiatry. While some patients are uncomfortable because we self-disclose so little, I believe that, on the whole, less is more. The standard we use is: Is this for the benefit of the patient, or myself? To gratify my own wish to chat about myself at the expense of a patient's time or comfort is not good psychiatry - or medicine I would say.

By the way, I'm impressed that you allow unmoderated comments here. Personally, I would delete obvious spam such as Martin's comment above.

Toni Brayer MD said...

Thanks Dr. Steve: done!

Anonymous said...

Dr. Reidbord,
i have found that if a psychiatrist lets me know very little about himself and/or has an office void of any type of "personal" type objects, that relationship is always doomed. The psychiatrists i have had the most sucessful "click" and relationship with and experienced the most positive treatment outcome are not afraid to allow themselves to tell a little about thier lives and experiences i f t h e s i t u a t i o n w a r r a n t s i t. With my personality, i cannot deal with a "tabula rusa".
thank you.

PS i wish you had a blog!

Anonymous said...

I began seeing a psychiatrist about a year ago and I feel uncomfortable about the amount of information he has revealed about himself. I find him a little too friendly, a little too casual and less professional in his conversational style & demeanor than other therapists and a psychiatrist I have encountered in the past. Every time I come in, he makes a point of giving me a huge, gushy complement. (Although I enjoy the complements, it feels over the top). He makes references to his family. His emails are professional but also contain friendly comments that are a opening to a conversation. Maybe that's part of the "therapy" of enhancing my self-esteem, but it is making me feel scared. He has a reputation for being a down to earth and friendly psychiatrist (a la Yalom) but I wish he would stick to the professional & traditional style I have grown accustomed to in therapy and with a previous psychiatrist (with each of these people I knew about 8 facts about their lives. That was enough). Since my psychiatrist has done a great job getting me on the right medications I am reluctant to stop seeing him. I really like him personally and respect his ability and intelligence as a psychiatrist, but the relationship has left me feeling confused. It makes me wonder whether he relates to all his patients this way or is it just me? (feeding my fantasy of being the "chosen one). He'll say 'enough about me' after talking about himself, but inevitably, at some point in the session, he'll mention something else about himself. I guess it feels more intimate than it should be. When I mentioned in one session that "boundaries are good", he responded by saying, "oh, don't get me started about boundaries." Well, I personally have three books on the subject and it seems clear to me that boundaries are boundaries. Any professional psychiatrist should understand this ( they're working with a vulnerable population, including myself). I am bipolar and was raised by a borderline mother so boundaries are something I feel that I must be particularly aware of at all times. Maybe this is just my psychiatrist's style, maybe he's trying to get closer to take advantage of me, maybe it's all in my head (a projection). There seems to be no way for me to know at this point. My strategy at this point is to do what it takes to maintain boundaries without disclosing too much of my personal information and to discourage him for doing the same in our future sessions. Bottom line is: he's in a position of power over me. I am not willing to be exploited for his own personal motives (if that is his intent). If the tone of the relationship doesn't change, I think it's best that I seek another psychiatrist.

Quiact said...

Should the physician tell the patient that the drug the physician is prescribing the patient is made by the company that gifts the physician.

Should the physician tell the patient the kickback the physician gets from managed care companies for switching a branded medication the patient is taking to a generic one?

Generic Viagra said...
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kamagra said...

Really? I have not idea of this. Physician self disclosure is a topic very difficult to find online, but here you even share different percentages about its impact across the world.

Steve Emanuel said...
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