What do physicians tell patients about themselves? A qualitative analysis of physician self-disclosure.
OBJECTIVE
Physician self-disclosure (PSD) has been alternatively described as a boundary violation or a means to foster trust and rapport with patients. We analyzed a series of physician self-disclosure statements to inform the current controversy.


METHODS
Qualitative analysis of all PSD statements identified using the Roter Interaction Analysis System (RIAS) during 1,265 audiotaped office visits.


METHODS
One hundred twenty-four physicians and 1,265 of their patients.


RESULTS
Some form of PSD occurred in 195/1,265 (15.4%) of routine office visits. In some visits, disclosure occurred more than once; thus, there were 242 PSD statements available for analysis. PSD statements fell into the following categories: reassurance (n = 71), counseling (n = 60), rapport building (n = 55), casual (n = 31), intimate (n = 14), and extended narratives (n = 11). Reassurance disclosures indicated the physician had the same experience as the patient ("I've used quite a bit of that medicine myself"). Counseling disclosures seemed intended to guide action ("I just got my flu shot"). Rapport-building disclosures were either humorous anecdotes or statements of empathy ("I know I'd be nervous, too"). Casual disclosures were short statements that had little obvious connection to the patient's condition ("I wish I could sleep sitting up"). Intimate disclosures refer to private revelations ("I cried a lot with my divorce, too") and extended narratives were extremely long and had no relation to the patient's condition.


CONCLUSIONS
Physician self-disclosure encompasses complex and varied communication behaviors. Self-disclosing statements that are self-preoccupied or intimate are rare. When debating whether physicians ought to reveal their personal experiences to patients, it is important for researchers to be more specific about the types of statements physicians should or should not make.
Beach
Mary Catherine
MC
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. mcbeach@jhmi.edu
Roter
Debra
D
Larson
Susan
S
Levinson
Wendy
W
Ford
Daniel E
DE
Frankel
Richard
R
D003376:Counseling; D030881:Disclosure; D004243:Divorce; D013502:General Surgery; D006801:Humans; D010817:Physician-Patient Relations; D011320:Primary Health Care