In well-intentioned efforts to establish relationships,
some physicians tell patients about their own family
members, health problems, travel experiences and
While such disclosures seem an important way to
build a personal connection, a University of Rochester
School of Medicine and Dentistry investigation of
secretly-recorded first-time patient visits to experienced
primary care physicians has found these personal
disclosures have no demonstrable benefits and may
even disrupt the flow of important patient information.
The journal Archives of Internal Medicine publishes
the surprising results of the investigation in the
June 25 issue. The investigators found physician
self-disclosures in about a third of patient visits.
The disclosures "were often non sequiturs, unattached
to any discussion in the visit and focused more
on the physician's needs than the patient's needs."
The disclosures "interrupted the flow of information
exchange and valuable patient time in the typically
time-pressured primary care visit." Investigators
found no examples of a physician making a statement
that led back from the self-disclosure to the patient's
"Most doctors think self-disclosure is a good idea
for building relationships," said Susan H. McDaniel,
Ph.D., lead author of the article and a professor
of psychiatry and family medicine at the University
of Rochester School of Medicine and Dentistry. "The
health care system now requires doctors to see many
patients. Visits to the doctor often are short and
anything that is a waste of time takes away from
getting to what the patient needs."
The psychologists and physicians who conducted
the investigation began the research believing that
self-disclosure was an effective way to encourage
patients to say more about what really troubled
"We were hoping to find that physician disclosure
would be a part of patient-centered care, encouraging
the patient to open up and offer additional valuable
information," said Howard B. Beckman, M.D., a co-author
of the article and a clinical professor of medicine
and family medicine at the School of Medicine and
Dentistry. "Instead we found these disclosures to
be doctor-centered and to benefit the doctor, not
the patient. As a discloser myself, I was really
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.
Here is an example of one brief exchange:
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 the right age
to be dating, I guess. So let's see. No trouble
urinating or anything like that"
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 patient's 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 day's news or vent about problems,
eliminating those kinds of self-disclosures from
patient sessions. Beckman, who is medical director
of the Rochester Individual Practice Association,
has stopped telling his elderly patients about his
mother, who was very active and healthy through
"I would tell people their expectations could be
higher and use my mother as an example," Beckman
said. "In subsequent visits, they asked about my
mother. That was great until her health began to
decline then I had to tell them she was not well.
That frightened them. If I couldn't help my own
mother, how could I help them" My disclosure did
not work as well as I had hoped."
"Patients want their needs met. Doctors want to
meet the needs of their patients and they want to
have human contact," said McDaniel, who is director
of the Wynne Center for Family Research at the University
of Rochester Medical Center. "But self-disclosure
ultimately is misguided. Patient visits should be
focused on the patient. They are not about me."
While a physician's self-disclosures usually develop
from positive intentions, the investigators said
that empathy, understanding and compassion toward
the patient are more reliable and helpful for the
"If I tell my patients about my problems or how
I feel, they are taking care of me," Beckman said.
"Is taking care of me the only way to deepen the
relationship" There are other ways. We can have
empathy. We can encourage our patients. We can praise
them -- things that make a person feel valued."
McDaniel hopes physicians use the article to examine
the way they conduct their practice and consider
whether self-disclosures are in the best interest
of their patients. She wants medical schools to
include more discussions of methods of communication
with patients in their curriculum.
"Doctors need support groups, self-awareness groups
and mindfulness groups to meet their needs," McDaniel
said. "They should not use self-disclosure. If they
want to complain about their rent or the stress
of the work, they should complain to their colleagues,
not their patients."