Whether or not “self-disclosure” is an effective communication strategy in the doctor-patient relationship has been debated. In fact, some studies have demonstrated that doctors who talk about themselves more are rated more poorly by patients than those who are more private. This topic has been of interest to me and I have written about it in my blog: Doctor, Patient, Friend: Blurring the Boundaries, and explored it further in a recent book chapter in Social Media in Medicine.
In the case of teachers and students, communication strategies that promote “immediacy” have been found to have positive results in terms of promoting learning by creating a more open classroom environment. Humor and self-disclosure are two strategies that promote immediacy. But, are these communication strategies effective in medicine also? I hypothesize that they are.
Recently a patient visited me to follow up after an E.R.
visit. While she was in the office I recounted to her a personal tidbit that
related to her day in the E.R. While
she and I were on the phone and as I was advising her the preceding Saturday afternoon, I had walked
outside of a local sub-shop, Dave’s Cosmic Subs, seeking out private place to
talk. On doing so, I had stepped beneath a tree into a pile of fire ants and was
bitten all over my feet, which caused a degree of distraction. For
this reason I ended the phone call somewhat abruptly and later called her back. Was
this self-disclosure helpful? She found it amusing, but we didn’t lose much
time over the conversation. A few days later she made mention of it again as we chuckled together about life's annoyances.
In another recent conversation with a patient who was
considering various hormonal options for peri-menopausal symptoms I revealed my
personal experience with using a Mirena IUD.
Several weeks later she decided this might be a good option for her as
well.
Were these personal self-disclosures to my patients helpful
or harmful? In the role of patient, I’ve been to see physicians who recount
personal stories during an office visit that seem to take time away from my
talk-time. In a dentist's office this can provide pleasant distraction as one is held captive with her mouth open, but in a doctor's office it can be annoying to a
patient when one knows that time is limited. Nonetheless, physicians, with their expert
knowledge of medicine, process medical information in the context of their own
lives in ways that are sometimes helpful to patients to learn about by way of
example.
I have, on more than one occasion, shared the story: when I
turned forty I was diagnosed with hypertension.
Three months after stopping oral contraceptive pills my blood pressure
normalized. I suspect that I will
eventually need blood pressure medication, in light of my strong family history
and current readings (130s/80s), and also despite my normal BMI and daily exercise. However, I
will try to stave it off for a few more years. Are these tidbits of
personal experience helpful for me to share with my patients?
As physicians increasingly engage in social media the
question of appropriate self-disclosures becomes more relevant. Should a doctor “friend” a patient on
Facebook? How should a physician conduct his or herself on Twitter? Self-disclosure is the norm for much
participation in social media. The AMA has published guidelines for social
media use by medical professionals. My own
theory is that physician self-disclosure can help promote intimacy and
trust between doctor and patient—qualities that are increasingly lacking in the
patient-physician relationship. I might
point out that in the case of social media, self- disclosures do not occur in
the context of office visits, and as such are extra communications that
don’t take time away from a patient’s precious appointment time.
Recently I was interested to read about a series of studies
published in the Proceedings of the National Academy of Science. The studies, led by Harvard psychology researchers Diana I. Tamir and Jason P.
Mitchell, made the relatively intuitive discovery: humans get a biochemical buzz from self-disclosure. By inference,
perhaps doctors who share more with their patients are happier with their
patient interactions than those who are more reserved, and perhaps those
positive feelings translate into a more effective health care experience. No one knows, and more
study is needed to uncover exactly what forms of physician self-disclosure are
helpful to patients and what forms are more self-serving, or “narcissistic,” detracting from the patient-physician relationship.
