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Enough About You, What About Me?

Susan H. McDaniel, PhD; Howard B. Beckman, MD; Diane S. Morse, MD; Jordan Silberman, MAPP; David B. Seaburn, PhD; Ronald M. Epstein, MD

Arch Intern Med. 2007;167(12):1321-1326.

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.

Author Affiliations: Departments of Family Medicine (Drs McDaniel and Epstein), Psychiatry (Drs McDaniel, Seaburn, and Epstein), and Internal Medicine (Drs Beckman and Morse) and the Rochester Center to Improve Communication in Health Care (Drs McDaniel, Beckman, Seaburn, and Epstein and Mr Silberman), University of Rochester School of Medicine and Dentistry, Rochester, NY; the Rochester Individual Practice Association (Dr Beckman); Department of Medicine, Rochester General Hospital (Dr Morse); and the Family Support Center of the Spencerport Schools, Rochester (Dr Seaburn).

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