The way you interact with your
patients on a personal level is in many ways just as
important as the way you treat them medically. But sharing
personal stories with patients is at best useless and
at worst detrimental to building physician-patient relationships,
according to a study published June 25 in Archives
of Internal Medicine.
The vast majority of physician
self-disclosures (MD-SD) — from weight problem
confessions to dating woe commiserations — were
a complete waste of time, found the University of Rochester
physician researchers who recorded actors posing as
patients during physician visits. A whopping 85% were
deemed to have no value to the patient. Only 4% of MD-SDs
were considered helpful, including physicians' comments
that either educated the patient or made them feel more
comfortable. But more than twice that number —
11% — were classified as disruptive. The study
describes these as "extended monologues that distracted
from the patient's concern and used up valuable visit
time."
"I was confident that [self-disclosure]
deepened the relationship between doctor and patient
so that patients would tell more about their condition,"
one of the study's authors, internist Dr Howard Beckman,
told the Wall Street Journal. The study's results,
he added, were "very disappointing."
CHATTERBOX
DOCS
About a third of the primary care visits recorded in
the study included at least one MD-SD. Shockingly, only
11% of MD-SDs were related to the patient's diagnosis.
The rest were about the doctors' personal life or feelings,
family, colleagues or work life.
So is self-disclosure a waste of
time? Regrettably, it appears it is — at least
in the form that was most commonly observed in the study.
Dr Beckman told the Journal he's learned his lesson
and changed his own MD-SD approach. "Because when I
bring up my own situation, some part of me starts thinking
about myself and that part of me stops thinking about
the patient's needs," he said.
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Quiz: When to shut up
Of the following four
real conversations recorded over the course
of the Rochester physicians' research, which
do you think was classified as "useful,"
"not useful" and "disruptive?" (Answers
below)
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1.
A COUPLE OF FISH IN THE SEA
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?
A) Useful B) Not useful C) Disruptive
2.
MIXING BUSINESS WITH... BUSINESS
Patient: I was concerned when I saw your
"For Rent" sign here. I thought you might
be moving. Are you going to stay here?
Physician: Oh yeah. There are two different
offices upstairs. They are both rented right
now, but one of the people will be moving
out in September. It's very hard to rent
sometimes. Sometimes you're lucky and somebody
just comes along, and other times you're
just not so lucky. Why, do you want to rent?
Patient: Nope.
Physician: Give you a good price.
Patient: No, I just wanted to find out what's
going on, really.
Physician: Okay, wha t can I do for you?
A) Useful B) Not useful C) Disruptive
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3.
ME TOO, I HAVE THAT!
Physician: I suffer from it myself.
Patient: Oh, you're kidding me?
Physician: Absolutely.
Patient: So what I'm saying to you is...
what you have? The exact same thing?
Physician: Exactly.
Patient: Oh, my gosh!
Physician: Exactly.
Patient: What a coincidence.
Physician: Basically the acids in the stomach
are coming back up. That's the reflux. And
that really irritates the lining of the
esophagus.
A) Useful B) Not useful C) Disruptive
4.
WHO'S THE FAIREST?
Patient: I'm six feet, and she just told
me I was 204.
Physician: Is that up a little bit for you
weight-wise?
Patient: it might be up a few pounds I used
to jog and I just haven't
Physician: See, 'cause I'm weighing more
like 172, 173, and I'm six foot and I'm
still running I'm still doing the 5 and
10 and 15 Ks. The half-marathons and
Patient: So I'm 30 pounds heavier than you?
Physician: Right now, yeah.
A) Useful B) Not useful C) Disruptive
Answers: 1 C; 2 B; 3
A; 4 C
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