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

摘要

Patients want a relationship with a physician with whom they can talk freely, and physicians vary in how they engage with patients. One form of engagement is self-disclosure, in which the physician reveals something personal about himself or herself. Historically, self-disclosure has been considered unacceptable in both psychiatry and medicine. Freud advocated that psychotherapists act as blank slates, and Osler advised physicians to maintain aequanimitas or impartiality (1). Recent psychodynamic literature stresses boundaries, calling clinician self-disclosure risky, potentially motivated by projection, and distracting to patients (2–5). nnNevertheless, recent studies reveal that primary care physicians are talking about themselves to 25% to 30% of patients, and that these disclosures may not be effective in increasing rapport, conveying understanding, or helping patients engage in improved self-care (6–8). Using simulated dialogue as illustration for primary care physicians and drawing on theory and evidence in the literature, we discuss the effectiveness of physician self-disclosure and offer practical suggestions. We focus mainly on spontaneous verbal self-disclosures (for example, information that the physician offers about his or her own physical or mental health, personal life, or beliefs, but not in response to a patient question) and make recommendations for improving or replacing these disclosures on the basis of research we and others have conducted. We then briefly discuss inadvertent disclosure and patient requests for self-disclosure.