Physician Self-disclosure Research Articles

Learner Experiences of Preceptor Self-Disclosure of Personal Illness in Medical Education.

The notion of physician invulnerability to illness contributes to the ongoing marginalization of physicians with personal experiences of illness and complicates professional identity development in medical learners. As such, physician self-disclosure of lived experiences as patients has seen an increasing role in medical education. Existing literature, centered on mental health, has characterized the positive effect of physician discussion of experience with mental illness on medical students and residents. However, the ways learners process and understand physician illness stories beyond this context and their use in education remain unclear. This study aimed to explore undergraduate medical students' perspectives on physician illness discussions of both physical and mental illness, including their perceptions of its use as a pedagogical tool. This qualitative study followed an interpretive descriptive design using activity theory as a sensitizing concept. Semistructured interviews with medical students were conducted between January and April 2022 at McMaster University in Hamilton, Ontario, Canada. The authors analyzed transcripts using reflexive thematic analysis. Twenty-one medical students participated in interviews. Although rare, self-disclosure conversations occurred across varied settings and addressed diverse aspects of illness experiences. Discussions involved teaching of pathophysiology, career advice, and wellness guidance. Five themes were developed: the opposition of physicianhood, patienthood, and situating the learner identity; invisibility and stigmatization of physician illness; impact of preceptor stories on learners' relationship with medicine; challenging the "rules" of physicianhood; and situating self-disclosure in medical education. Students strongly appreciated physician self-disclosure conversations. Self-disclosure can act as an effective pedagogical tool by fostering expansive learning among medical students. Further research is necessary to explore physician perspectives and supports for self-disclosure in education.

The ill physician who self-discloses: What do patients think?

Background Physicians with a serious illness face difficult decisions about revealing this sensitive information to patients. Self-disclosure of illness is a largely unexplored topic, particularly from the patient’s perspective. Objectives To learn about patients’ emotions and reactions to their family physician’s sharing with them about having a major illness. Methods The study was carried out in a family practice office in a suburb of Jerusalem, beginning the day that a family physician returned to work after a prolonged illness. A questionnaire study was performed with nine closed and four open questions relating to patients’ reactions to learning about the illness. The questionnaire was distributed to 200 consecutive patients ages 18 years or older. Data extraction, compilation, and content analysis were performed to elicit and categorise major themes and issues that arose. Results A total of 82% of the patients were pleased that the physician shared the information with them and none were displeased. Patients expressed a wide range of reactions to being told of the illness by the physician himself, among them: empathy, surprise, appreciation, pride, criticism, comfort/discomfort, and closeness. The value of sharing personal experience and the unique connection with the family physician were emphasised. Conclusion Physician self-disclosure of major illnesses to patients can reveal the physician’s humanity, encourage empathy on the part of patients and strengthen the physician-patient relationship. This report adds to current knowledge about when to share this powerful information with patients and highlights the topic’s importance in the education of future doctors.

Should Physicians Disclose Their Own Health Challenges? Perspectives of Patients With Chronic Pain.

This study explores how patients with chronic pain view the impact of physician self-disclosure on the patient–physician relationship. We conducted mixed-methods analyses of a cross-sectional survey eliciting experiences and attitudes regarding physician self-disclosure among 934 adults with self-reported chronic pain. Patients with chronic pain commonly recalled experiences of physician self-disclosure, most often “small talk” or physicians’ disclosure of their own chronic pain. Patients generally rated these experiences to be beneficial. Patients frequently said they would benefit from seeing a physician who has had chronic pain, or that they would want their physician to self-disclose their own chronic pain. Those who had never experienced self-disclosure were more likely to want their physician to self-disclose their own chronic pain. Nonetheless, patients held varying perspectives toward the advantages and disadvantages of physician self-disclosure, believing that self-disclosure could either positively or negatively impact the patient–physician relationship and care and communication.

Physician empathy according to physicians: A multi-specialty qualitative analysis

ObjectivesTo explore how physicians in neurology, family medicine, internal medicine, and emergency medicine characterize clinical empathy. MethodsPhysicians (N = 94) were asked to describe up to 10 examples of empathic physician behavior. Data were analyzed using template analysis. ResultsPhysicians’ descriptions of clinical empathy patterned into three themes: Clinical Performance and Professionalism, Interpersonal Communication, and Clinician Orientation. Clinical Performance and Professionalism subthemes included physician competency and accessibility; intersection with institutional resources; and spending/making/taking time with patients. Interpersonal Communication subthemes involved information sharing; verbal and nonverbal approaches; interpersonal sensitivity; physician self-disclosure; and attention to emotion. Clinician Orientation encompassed general physician demeanor and internal thoughts and feelings that might be unobservable by patients. Physicians varied widely in the themes they mentioned in their definition of empathy. ConclusionPhysicians hold diverse notions of clinical empathy. These extend beyond traditional affective and cognitive empathy definitions to include structural elements like team-based care and accessibility after hours. Communication behaviors were perceived as important for demonstrating empathy. Some physician descriptions of empathy may not be perceptible to patients. Practice ImplicationsTraining physicians to engage in behaviors that both they and patients perceive as empathic may lead to higher patient and physician satisfaction.

Empathy and boundary turbulence in cancer communication

ObjectivesTo describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent. MethodsThree standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations. ResultsWe identified patient-centered physician response categories--empathy, affirmation, and acknowledgement; and physician-centered categories—transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered. ConclusionsPhysicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication “boundary turbulence.” Patients may benefit from physicians’ improved use of empathy and boundary management.

The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician

ObjectivesPhysician self-disclosure is typically seen as patient-centered communication because it creates rapport and is seen as an expression of empathy. Given that many physician behaviors affect patients differently depending on whether they are shown by a female or male physician, we set out to test whether physician self-disclosure affects patients’ intentions to self-disclose and patients’ perceptions of their physicians depending on physicians’ gender. MethodTwo hundred and forty-four participants were recruited and randomly assigned to read one of 4 vignettes as if they were the patient in the dialogue (analogue patient design). They were then asked to report how they would react to the physician and how they perceived the him or her. ResultsPhysicians who self-disclosed were perceived as more empathic than physicians who did not, regardless of physician and patient gender. Physician self-disclosure had an effect on the behavioral intentions of the analogue patients, and this was moderated by physician gender. Analogue patients indicated to be more willing to self-disclose to female than to male physicians who self-disclosed. ConclusionIt is important to consider physician gender when training physicians in patient-centered communication because the same behavior can have different effects on patients depending on whether it originates from a female or a male physician. Practical implicationsPhysicians can use self-disclosure to express empathy. When female physicians do so, they might obtain more personal information from patients, which can positively affect diagnosis and treatment.

Physician Self-disclosure of Lived Experience Improves Mental Health Attitudes Among Medical Students: A Randomized Study.

Introduction:Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physicians.Methods:We surveyed second-year medical students using the Attitudes to Psychiatry (ATP-30) and Attitudes to Mental Illness (AMI) instruments. In addition, we asked questions about role-modeling and help-seeking attitudes at baseline. We then conducted a randomized trial of an intervention consisting of 2 components: (a) a panel of 2 physicians with personal histories of mental illness speaking about their diagnosis, treatment, and recovery to the students, immediately followed by (b) small-group facilitated discussions. We repeated the ATP-30 and AMI after the active/early group was exposed to the panel, but before the control/late group was similarly exposed.Results:Forty-three medical students participated (53% women). The majority of students (91%) agreed that knowing physicians further along in their careers who struggled with mental health issues, got treatment, and were now doing well would make them more likely to access care if they needed it. Students in the active group (n = 22) had more favorable attitudes on ATP-30 (P = .01) and AMI (P = .02) scores, as compared with the control group (n = 21).Conclusion:Medical students can benefit from the availability of, and exposure to physicians with self-disclosed histories of having overcome mental illnesses. Such exposures can favorably improve stigmatized views about psychiatry, or of patients or colleagues affected by psychopathology. This intervention has the potential to enhance medical students’ mental health and their health-seeking behaviors.

"Let Me Tell You About My…" Provider Self-Disclosure in the Emergency Department Builds Patient Rapport.

IntroductionAs patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD) of personal information by primary care providers decreased patient rating of the provider communication skills.ObjectiveThe objective of this study was to explore the incidence and impact of emergency department (ED) provider self-disclosure on patients’ rating of provider communication skills.MethodsA survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers’ communication skills. We compared patients’ ratings of communication measurements between encounters where self-disclosure occurred to those where it did not.ResultsPatients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (p<0.05), more positive ratings of provider rapport (p<0.05) and higher satisfaction with provider communication (p<0.05). Patients who noted SD scored their providers’ communication skills as “excellent” (63.4%) compared to patients without self-disclosure (47.1%). Patients reported that they would like to hear about their providers’ experiences with a similar chief complaint (64.4% of patients), their providers’ education (49%), family (33%), personal life (21%) or an injury/ailment unlike their own (18%). Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport.ConclusionProvider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction.

A qualitative content analysis of HIV consultation: when conversation is about aother than disease

In recent decades the literature has paid growing attention to the communicative and relational aspects of the medical consultation, showing a consistent presence - besides contents related to the disease and the patient's agenda - of friendly conversations or "chitchat", i.e. interventions related to social, relational and personal aspects made by the physician or by the patient. The aim of the study is to analyze the content, frequency and who between the doctor and the patient introduce the "chitchat" during the check-up visits with HIV+ patients and assess the patient satisfaction at the end of the visit. 52 visits at the clinic of Infectious Diseases in a hospital in Northern Italy were videotaped and transcribed. All patients filled out a satisfaction questionnaire at the end of the visit. The friendly conversations were extrapolated, and analyzed qualitatively with a content thematic analysis, and quantitatively using descriptive statistics. The following thematic areas were identified: patient's medical issue not related to HIV; medical condition of a family member or others; labour issues of the patient; patient's relational/emotional issues; relational/working issues work of others; social conversations; physician's self-disclosure. "Chitchat" accounted for 26.5% of the time of the visit and in 63% of cases was introduced by doctors. The 91.4% of the patients was highly satisfied. The presence of friendly conversations during the doctor-patient exchanges in the field of HIV infection seems to have a role of consolidation of the therapeutic relationship and seems to reflect an authentic interest of the physician towards the patient as a person.

Physician self-disclosure in primary care: a mixed methods study of GPs' attitudes, skills, and behaviour.

There is a debate in medicine about the use and value of self-disclosure by the physician as a communication tool. There is little empirical evidence about GPs and self-disclosure. To explore what GPs' attitudes, skills, and behaviour are with regard to self-disclosure during a clinical consultation and whether there is a need for the development of training resources. Mixed methods using open-ended and semi-structured interviews in Auckland, New Zealand, and the surrounding districts. Sixteen GPs were interviewed on the issue of self-disclosure in clinical practice. A general inductive approach was used for data analysis. Self-disclosure was common in this group of GPs, contrary to training in some of the groups, and was seen as a potentially positive activity. Family and physical topics were most common, yet psychological and relationship issues were also discussed. Knowing patients made self-disclosure more likely, but a GP's intuition played the main role in determining when to self-disclose, and to whom. GPs have developed their own guidelines, shaped by years of experience; however, there was a consensus that training would be helpful. Self-disclosure is common and, in general, seen as positive. Major personal issues were acceptable for some GPs to self-disclose, especially to known patients. Although participants had developed their own guidelines, exposure of trainees to the issue of self-disclosure would be of value to prevent future mistakes and to protect both doctor and patient from any unintended harm, for example, developing a dependent relationship.

Pilot Study

INTRODUCTION: As many as one third of female health care providers use intrauterine contraception, but only 7.7% of U.S. women overall do. This begs the question: Might physician self-disclosure of intrauterine contraception use increase intrauterine contraception uptake among patients? However, the positive (or negative) effect of physician self-disclosure on intrauterine contraception uptake or patient satisfaction generally is unknown. METHODS: We performed a prospective randomized block design pilot trial of usual contraceptive counseling compared with usual counseling plus physician self-disclosure. We enrolled nine reproductive-aged obstetrics–gynecology providers from the University of Michigan, willing to disclose intrauterine contraception use, and 132 patients aged 18–45 years being seen for a family planning, annual examination, or general gynecology visits. We recruited, screened, and enrolled patients at the time of their visit; they were then randomized by date of visit. Patients completed surveys preintervention, postintervention, and 2 months later. A series of linear mixed models were used to assess the outcomes and account for the repeated measures per study participant. RESULTS: Differences between those with physician self-disclosure and without physician self-disclosure were not found for current intrauterine contraception use, likelihood of future intrauterine contraception use, or satisfaction with contraceptive method, health care provider, or overall experience when controlling time, health care provider type, patient age, and parity (P value range .056–.975). CONCLUSIONS: Physician self-disclosure did not increase intrauterine contraception use or likelihood of future intrauterine contraception use and did not negatively affect patients' overall satisfaction with their clinical encounter. Health care providers can use this as part of their contraceptive counseling when appropriate without negative effect. Additional research is needed to further understand the effect of physician self-disclosure in other contexts.

Is Physician Self-Disclosure Ever Appropriate?

Physicians should be mindful of the choice to self-disclose to a patient. Self-disclosure can be a useful tool, but only if it is intended to serve the patient and not the doctor.

Commentary on “Life as a Pregnant Genetic Counselor: Take Two”

Commentary on “Life as a Pregnant Genetic Counselor: Take Two”

Exploring the Relationship Between Pediatrician Self-Disclosure and Parent Satisfaction

Patient satisfaction is a frequently explored outcome in physician–patient communication research. One variable that may influence patient satisfaction, but that has not been extensively explored, is physician self-disclosure (SD). This study examined the effect of pediatrician SD on parent satisfaction in the context of a “sick child” office visit. Results showed that parents were more satisfied with visits in which pediatricians self-disclosed than with those in which pediatricians did not self-disclose. Implications of the study's results and directions for future research are discussed.

Correction: Enough about Me, Let's Get Back to You: Physician Self-disclosure During Primary Care Encounters

Correction: Enough about Me, Let's Get Back to You: Physician Self-disclosure During Primary Care Encounters

Physician Self-Disclosure at the End of Life: Is it Beneficial?

Physician Self-Disclosure at the End of Life: Is it Beneficial?

Correction: Physician Self-disclosure During Primary Care Encounters

Correction: Physician Self-disclosure During Primary Care Encounters

“Enough about Me, Let's Get Back to You”: Physician Self-disclosure during Primary Care Encounters

Although the medical profession frowns on physicians who tell patients about their own health problems (self-disclosure), the practice is probably common. The authors use simulated dialogue and dra...

Physician Self-Disclosure and Patient Counseling

As I looked at the monitor, my eyes filled with tears: cervix measurement—6 mm. I knew what that meant because I had been here before. That time, I had been 18 weeks pregnant with a short cervix and it was a sad ending. This time things looked worse. My cervix was shorter and I was carrying twin A and twin B. My blur of tears was interrupted only by the nurse taking vital signs and bad television. "No, I don't want visitors." "No, I am not interested in a support group."

Physician Self-disclosure

Physician Self-disclosure