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Disclosing information: How much is too much?
Patients gain little from doctors' disclosures
Physicians say they sometimes struggle to strike a balance in their doctor-patient relationships — not too personal, not too aloof. In trying to be warm and empathetic, however, "physicians should always keep the focus of the conversation on the patient," says Diane Morse, MD, an associate clinical professor at the University of Rochester (NY) School of Medicine and Dentistry.
But a study she and several colleagues completed recently provides proof that sometimes when a physician shares personal information with a patient, it amounts to too much about the doctor and not enough about the patient.
The researchers "listened in" by gathering transcripts of audiotaped patient visits to 100 Rochester-area internists. The "patients" were standardized subjects who were trained to depict specific patient presentations. Each physician agreed to two unannounced, undisclosed audiotaped patient visits; a few of the 193 recordings obtained were discarded for quality, and 76 were discarded because the physician detected that the patient was a standardized subject. But from the 113 good recordings, and the surveys completed by physicians during the research period, the investigators drew some conclusions about the usefulness of physicians' self-disclosures (MD-SD) to their patients.
'Less about you, more about me'
"A lot of time, we found that the focus of the conversation didn't originate from or go back to the patient, and that focus is important," says Morse.
One example mentioned in the study:1
Physician: No partners recently?
Patient: I was dating for a while and that one just didn't work out. . . about a year ago.
Physician: So you're single now.
Patient: Yeah. It's all right.
Physician: [laughing] It gets tough. I'm single as well. I don't know. We're not at the right age to be dating, I guess. So, let's see. No trouble urinating or anything like that?
The problem with this exchange, the authors explain, is that the physician shifted the focus to himself, then abruptly changed the subject, not allowing the patient the chance to respond.
"Our observation, from reading and listening, is that the focus didn't go back to the patient as much as it should have," Morse says.
In fact, the authors of the paper on the study said that out of all 113 transcripts, there was no example of a physician making a transition statement leading back to the patient's concern and no example of a patient stating explicitly that the MD-SD was helpful in any way.
"What you need to ask yourself, if the idea to share personal information pops into your head, is why you are thinking of doing it?" Morse suggests. "Is there a reason to do it, or is there something else you could say that would be more helpful?"
Physicians' motives in sharing personal disclosures are often good; however, it doesn't always turn out that the disclosure is good for anyone but the doctor, Morse adds.
"A lot of time, those good feelings [physicians] are getting after sharing their personal information is a one-sided good feeling," she says. "They project that good feeling onto the patient when it really might not be there."
In fact, the Rochester study indicated that only three of the MD-SDs (4%) were coded by the researchers as potentially useful — providing education, support, explanation, or acknowledgment, or prompting some indication from the patient that it had been helpful.
Check your motives, then keep it brief
In some cases, physicians' motives seemed to be to gain support from their patients, rather than to give it — for example, one doctor described her concerns over her daughter going to camp and her loneliness at her absence. Another physician, seeing a patient who might have had weight concerns, pointed out his own weight (which was 30 pounds less than the patient's) and described his own athletic abilities as a runner.
Neither of those encounters, the authors conclude, were to the benefit of the patient.
In some cases, describing a unique shared experience — personal experience with a family member having life support withdrawn, for example, or with an unusual similar disease — might seem to be supportive and welcomed by the patient. Morse says even those kinds of disclosures need to be examined first.
"Sometimes, it's better to think about what else you could do; maybe empathy would be more effective," she suggests. "Instead of saying 'I have had that happen to me, too,' say, 'I know how hard this is for you.'" This keeps the focus of both patient and physician where it should be — on the patient.
"Also, keep it short. You can be empathetic, but be brief," Morse continues. "A lot of these conversations can be time-consuming, so given the fact that your time is limited, how ethical is it for a doctor to decide how that time is spent unless it's spent on the patient?"
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