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Don't Tell Me What's Up, Doc

Personal disclosures by physicians can disrupt patient communication, study says

MONDAY, June 25, 2007 (HealthDay News) -- Rather than enhancing the doctor-patient relationship, when physicians share personal information with their patients, patient care may suffer, new research suggests.

The study, which was conducted using actors posing as new patients unbeknownst to the doctors, found that physicians disclosed personal information in about one-third of office visits, and 85 percent of these disclosures weren't helpful to the patient.

"Doctors may try to humanize their interactions with patients, but it didn't seem helpful," said the study's lead author, Susan H. McDaniel, associate chairwoman of the department of family medicine and director of the Wynne Center for Family Research at the University of Rochester School of Medicine and Dentistry in New York. "We were quite surprised at how much personal disclosures functioned as distractions to patient-centered care," she added.

Results of the study are published in the June 25 issue of the Archives of Internal Medicine.

Not everyone is convinced that personal self-disclosures hinder rather than help doctor-patient relationships, however.

"If self-disclosure is used as a tool to help develop the relationship, it could be useful. While today's time constraints are phenomenal, used properly, self-disclosure can be a time-saving and relationship-building tool," said Dr. Eric Goldberg, a clinical assistant professor at New York University School of Medicine, and a private practice internist at Murray Hill Medicine Group in New York City.

Goldberg also said that in real-life practice -- as opposed to actors posing as patients -- patients often bring up personal questions, such as whether or not the doctor has any children. Ignoring such a question, he said, wouldn't help the doctor-patient relationship.

McDaniel said she and the other researchers began the study believing that they would find that personal disclosures by physicians were helpful. To see if that was the case, the researchers recruited 100 physicians to participate in what they were told was a study of patient care and outcomes. Each of the physicians was to see one male actor and one female actor posing as patients; the doctors weren't told these were not real patients. However, about 40 percent of the interviews weren't included in the final analysis, because the physician realized that the actor wasn't a real patient before the end of the visit.

So, 113 visits were included in the final analysis. Of those visits, 34 percent contained at least one physician self-disclosure. Many of those disclosures -- 38 percent -- occurred during the information-gathering part of the office visit, prior to the physical exam.

The self-disclosure was rarely (14 percent) linked to a direct request for personal information from the patient but was related to the conversation about two-thirds of the time.

Seventy percent of the time, the patients responded to what the physicians were talking about rather than return to their own concerns. After the self-disclosure, some doctors abruptly changed the subject, as in this exchange from the study:

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 researchers found that 85 percent of the self-disclosures weren't helpful to the patient, and 11 percent were considered disruptive to patient care. Goldberg pointed out that the actors may have been less likely than real patients to bring the conversation back to what was troubling them.

McDaniel said that time constraints are one of the biggest reasons that personal disclosures affect patient care. "There's really little time to do anything, and physician self-disclosures don't increase patient self-disclosure, in fact, they seem to distract attention from the patient."

McDaniel also said that, in some cases, these disclosures may stem from the doctor's need for human contact and interaction. "It's an understandable social interaction, but it's clearly a distraction. And, there's not a lot of extra room -- there's no buffer of time for a two-way exchange," she said. She suggested that physicians join -- or start -- consultation groups, where doctors get together to discuss the stresses and challenges of practice in health care today.

While Goldberg believes there's definitely a place for some personal disclosure in the doctor-patient relationship, he said it's important that those interactions "are focused on the patient and are to build rapport with the patient, rather than just giving information for the heck of it."

McDaniel suggested that patients should go to their physicians prepared with an agenda so "you can make sure you're getting your needs met."

More information

For advice on communicating effectively with your doctor, visit the American Academy of Family Physicians.

SOURCES: Susan McDaniel, Ph.D., professor of psychiatry and family medicine, associate chairwoman of the department of family medicine, director of the Wynne Center for Family Research, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; Eric R. Golberg, internist, Murray Hill Medical Group, and clinical assistant professor, New York University School of Medicine, N.Y.; June 25, 2007, Archives of Internal Medicine
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