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Personal Disclosure by Physician may Harm Patients

r, not the patient. As a discloser myself, I was really devastated.

The investigation is part of a larger study of patient communication and health outcomes funded by the Agency for Healthcare Research and Quality. One hundred primary care physicians in the Rochester region agreed to participate, consenting to two unannounced and secretly recorded visits by people trained to portray specific patient roles.

The project produced 193 recorded first-time patient visits to primary care physicians. For the self-disclosure investigation, four recordings were eliminated for poor technical quality and 76 were excluded because the physician suspected the patient was not a true patient before the end of the visit. Self-disclosures were defined as physician statements about his or her own personal or professional experience.

Each investigator independently reviewed and analyzed 113 transcripts of patient visits, rating the content for self-disclosure and its effect on the patient. Thirty-four percent of the visits contained at least one self-disclosure. None of the self-disclosures were patient focused, while 60 percent were physician focused, the investigators concluded. Eighty-five percent of the disclosures were considered not useful and 11 percent were viewed as disruptive.

Although occasionally it might be useful for physicians to answers inquiries from patients about their personal life or to comment on a specific topic raised by a patient, such discussions generally should be very short and clearly tie into a patients concerns, the authors of the article concluded.

Those involved in the investigation said the findings have affected how they conduct their practice. McDaniel, for example, now takes breaks between patient visits to discuss the days news or vent about problems, eliminating those kinds of self-disclosures from patient sessions. Beckman, who is medical director of the Rochester Individual Pract
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