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Personal disclosures by physicians may disrupt patient care
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CHICAGO—In a study involving unannounced visits by actors portraying new patients, primary care physicians shared personal information about one-third of the time, according to a report in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Only 10 (14 percent) of these disclosures were in response to a patient question, and most (62, or 85 percent) appeared not to be useful to the patient.


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Communication between physicians and patients appears to improve patients’ health, but little is known about how best to create healing relationships, according to background information in the article. “In particular, physician self-disclosure, when the physician shares personal information and/or experiences, has generated controversy,” the authors write. “Despite seeming to be a way to strengthen the patient-physician relationship, recent evidence has called this into question.”

Susan H. McDaniel, Ph.D., of the University Rochester School of Medicine and Dentistry, N.Y., and colleagues recruited 100 primary care physicians, who agreed to have actors portraying new patients visit their offices unannounced in 2000 or 2001. The researchers then analyzed transcripts of 113 visits between the physicians and the actors, who were trained to represent standardized patients with common complaints (gastrointestinal reflux disease or unexplained symptoms). Visits in which the physician suspected the patient were actors were not included in the results. Self-disclosures were defined as instances where physicians made statements about personal or professional experiences, including family members, health problems, interactions with other health care professionals or political beliefs.

In 38 (34 percent) of 113 visits, 73 separate physician self-disclosures were identified. These occurred throughout the visit but most often (38 percent) during the time when the physician was taking a medical history or gathering information about the patient before the physical examination. “Forty-four (60 percent) followed patient symptoms, family or feelings; 29 (40 percent) were unrelated,” the authors write. “Only 29 encounters (21 percent) returned to the patient topic preceding the disclosure.”

“Only three physician self-disclosures (4 percent) were coded as useful—providing education, support, explanation or acknowledgement, or prompting some indication from the patient that it had been helpful,” they continue. In all three of those cases, the physician disclosed that he or she had the same medical condition as the patient. Eight (11 percent) of the disclosures were considered disruptive, or detracting in some way from the physician-patient relationship. These included instances where the physician talked about himself or herself for an extended period of time, inadvertently competed with the patient, requested the patient’s support or expressed personal or political viewpoints that did not take the patient’s perspective into account.

“We found that physician self-disclosures were often non sequiturs, unattached to any discussion in the visit, and focused more on the physician’s than the patient’s needs. Longer disclosures, both not useful and disruptive, interrupted the flow of information exchange and expended valuable patient time in the typically time-pressured primary care visit,” the authors conclude. “Our analysis suggests that physician self-disclosure usually is of little value and, occasionally, can actually impair the physician-patient relationship. Primary care physicians may wish to make explicit decisions about any use of self-disclosure and consider using empathy and other ways of demonstrating support and building relationships.”
(Arch Intern Med. 2007;167:1321-1326.

Editor's Note: This research was supported by a grant from the University of Rochester Family Research Roundtable Small Grants Program (Dr. McDaniel) and a grant from the Agency for Healthcare Research and Quality, Rockville, Md. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .


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