Is physician self-disclosure related to patient evaluation of office visits?
BACKGROUND
Physician self-disclosure has been viewed either positively or negatively, but little is known about how patients respond to physician self-disclosure.


OBJECTIVE
To explore the possible relationship of physician self-disclosure to patient satisfaction.


METHODS
Routine office visits were audiotaped and coded for physician self-disclosure using the Roter Interaction Analysis System (RIAS). Physician self-disclosure was defined as a statement describing the physician's personal experience that has medical and/or emotional relevance for the patient. We stratified our analysis by physician specialty and compared patient satisfaction following visits in which physician self-disclosure did or did not occur.


METHODS
Patients (N= 1,265) who visited 59 primary care physicians and 65 surgeons.


METHODS
Patient satisfaction following the visit.


RESULTS
Physician self-disclosure occurred in 17% (102/589) of primary care visits and 14% (93/676) of surgical visits. Following visits in which a primary care physician self-disclosed, fewer patients reported feelings of warmth/friendliness (37% vs 52%; P =.008) and reassurance/comfort (42% vs 55%; P =.027), and fewer reported being very satisfied with the visit (74% vs 83%; P =.031). Following visits in which a surgeon self-disclosed, more patients reported feelings of warmth/friendliness (60% vs 45%; P =.009) and reassurance/comfort (59% vs 47%; P=.044), and more reported being very satisfied with the visit (88% vs 75%; P =.007). After adjustment for patient characteristics, length of the visit, and other physician communication behaviors, primary care patients remained less satisfied (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.24 to 0.81) and surgical patients more satisfied (AOR, 2.22; 95% CI, 1.12 to 4.50) after visits in which the physician self-disclosed.


CONCLUSIONS
Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.
Beach
Mary Catherine
MC
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. mcbeach@jhmi.edu
Roter
Debra
D
Rubin
Haya
H
Frankel
Richard
R
Levinson
Wendy
W
Ford
Daniel E
DE
D005260:Female; D013502:General Surgery / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D012650:Self Disclosure