Is sharing really caring? A review of the benefits and risks associated with physicians self-disclosing their personal illness experiences to their patients.

Abstract

Doctors experiencing personal illness are common1 and many clinicians have a history of conditions they also manage in their patients. Personally, I suffer from many of the allergic diseases I treat. I assumed my personal experience allowed a more in-depth ability to empathise with my patient's quality of life and treatment challenges and regularly used self-disclosure in consultations. I was challenged in a recent consultation by a health-literate parent who produced contrary evidence to the treatment strategy I was discussing. I had just shared my personal experience with this treatment modality. At the time I felt surprised, confronted and potentially our rapport was challenged. I had felt my narrative medicine approach had built mutual understanding. However, the parent had felt my personal reflections bordered on non-evidence based bias. The question arose does the use of self-disclosure in consultations enhance the depth of counselling or does it expose evidence-based recommendations to potential bias? When interviewed, many doctors who suffer serious illness perceive a positive effect on their patient communication skills as a result.2 Positive effects have also been reported regarding the depth of explanation and ability to divulge clinical reasoning/clinical uncertainty explicitly to their patients.2 It is challenging to leave you own disease experience at the door or to be informed by an aggregate of past patient experience. Why is personal illness experience often perceived as helpful? This is best said by American physician Janis Orlowski who stated in an interview ‘living an experience is different to intellectually understanding an experience’.3 Suffering the same disease as the patient is not a source of weakness, it can be a source of expertise. It is one thing for clinical expertise to be shaped by your experience but another to disclose that personal experience directly to a patient. The literature has shown self-disclosure is a common technique and potentially helpful when used judiciously.4 Self-disclosure is more commonly used by paediatricians than other specialists5 and is generally seen by patients as positive but comes with inherent risks.5 One primary care study showed many self-disclosures were spontaneous and can be disruptive if not patient focussed.6 Exploring whether doctor–patient self-disclosure leads to bias is a difficult question. The contrast of risk perception between clinician and patient is often obvious in the consultation room. A complex dynamic process involving personal and professional experiences often contextualises risk and how statistics are presented. This potential for statistical framing bias has been shown in a randomised trial to be just as common in doctors as their patients.7 While we may strive to include evidence-based medicine in our practice, it has been described to have inherent biases against patients by design.8 These limitations may be from the limited patient input in research design to the insufficient attention to power imbalances that suppress the patient's voice.8 Primarily the question remains: does sharing my experience diminish patient choice/autonomy or provide context to make choices easier? Whilst self-disclosure use is common and may improve communication skills,2 if misdirected and physician-focussed it can lead to negative patient outcomes.6 In order to practice truly patient-centred care, regular reflection is required. Clinicians should consider regular patient feedback and reflecting on their own needs (e.g. validating their own illness experiences) to utilise self-disclosure appropriately.