Physician self-disclosure in primary care visits: enough about you, what about me?
BACKGROUND
The value of physician self-disclosure (MD-SD) in creating successful patient-physician partnerships has not been demonstrated.


METHODS
To describe antecedents, delivery, and effects of MD-SD in primary care visits, we conducted a descriptive study using sequence analysis of transcripts of 113 unannounced, undetected, standardized patient visits to primary care physicians. Our main outcome measures were the number of MD-SDs per visit; number of visits with MD-SDs; word count; antecedents, timing, and effect of MD-SD on subsequent physician and patient communication; content and focus of MD-SD.


RESULTS
The MD-SDs included discussion of personal emotions and experiences, families and/or relationships, professional descriptions, and personal experiences with the patient's diagnosis. Seventy-three MD-SDs were identified in 38 (34%) of 113 visits. Ten MD-SDs (14%) were a response to a patient question. Forty-four (60%) followed patient symptoms, family, or feelings; 29 (40%) were unrelated. Only 29 encounters (21%) returned to the patient topic preceding the disclosure. Most MD-SDs (n=62; 85%) were not considered useful to the patient by the research team. Eight MD-SDs (11%) were coded as disruptive.


CONCLUSIONS
Practicing primary care physicians disclosed information about themselves or their families in 34% of new visits with unannounced, undetected, standardized patients. There was no evidence of positive effect of MD-SDs; some appeared disruptive. Primary care physicians should consider when self-disclosing whether other behaviors such as empathy might accomplish their goals more effectively.
McDaniel
Susan H
SH
Department of Family Medicine, University of Rochester School of Medicine and Dentistry, and Department of Medicine, Rochester General Hospital, NY 14620, USA. susanh2_mcdaniel@urmc.rochester.edu
Beckman
Howard B
HB
Morse
Diane S
DS
Silberman
Jordan
J
Seaburn
David B
DB
Epstein
Ronald M
RM
D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D009819:Office Visits; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000592:standards*; D012650:Self Disclosure