Clinician self-disclosure, if done thoughtfully, may help some patients feel better understood and strengthen the patient-doctor relationship.
Years ago, I sought medical attention for some odd paresthesias in my feet. When they didn’t resolve on their own, I became concerned since I had no evident medical problems, injuries, or medications that could explain my symptoms. After my neurologist did an extensive work-up and found no physiological or structural abnormalities to explain my symptoms, I decided to see another physician. He must have sensed my worry, so he shared with me that he’d gone through something similar in the past. He reassured me that he’d fully recovered and could point me to the way forward. I immediately felt a weight lifted off my shoulders knowing that my doctor knew firsthand what I was experiencing.
Following my physician’s recommendations, I made a full recovery. Our appointment profoundly shaped my perspective and has since motivated my interest in a rather niche but important area of patient-clinician communication—physician self-disclosure.
Clinician self-disclosure is broadly defined as any statement made to a patient that describes the physician’s personal experience. These statements span the gamut from casual small talk (“I attended the same college as you”) to shared illness experience (“I had the same cancer and I know how rough treatment can be”) to intimate private revelations (“My partner and I have also been fighting a lot”).
The use of physician self-disclosure in medicine is highly controversial. When done appropriately, clinician self-disclosure can enhance the patient-doctor relationship by helping the patient feel understood and cared for, enhance patient trust in their physician, and pave the way for more open and constructive communication about management and treatment of the patient’s condition. When misused, however, clinician self-disclosure can do the opposite. It can make the patient feel invalidated if their doctor superimposes or projects their own experience onto them, erode trust, and bias the physician’s treatment based on their personal beliefs, successes, or failures regarding treatment modalities.
The balance of risks and benefits of physician self-disclosure is also dependent on the context and nature of the disclosure and the motivation behind the disclosure. For instance, patients may better receive personal information from their clinicians with whom they have existing rapport. Moreover, patients may prefer that their doctors keep self-disclosures short but meaningful, using them as a way to express empathy but promptly redirecting focus onto the patient’s needs. Physicians who self-disclose to their patients in order to fulfill a personal need (to be heard and/or to vent) can often harm instead of help their patients.
For my Scholarly Concentration research project, I’ve been conducting my own study exploring the experiences and attitudes of patients with chronic pain toward physician self-disclosure. After receiving survey responses from over 900 patients, I’ve found that these same advantages, disadvantages, and complexities of physician self-disclosure hold true for patient-doctor relationships within the setting of chronic pain.
Inspired by my review of the medical literature on physician self-disclosure, as well as the valuable insights patients shared with me, I’ll now be consciously asking myself these questions whenever I consider self-disclosing to a patient:
1. What’s the real purpose of my self-disclosure?
This question concerns the motivation for self-disclosing, which should always be for the benefit of the patient. The self-disclosure must at the very least be to communicate to the patient that even if I don’t fully understand their experience, I’ve gone through something similar and am with them in their struggle. Self-disclosure can be a powerful expression of empathy if done with the right motivation. It can help patients be more transparent about their own experiences that they may not have otherwise been comfortable sharing. This can open doors for communication and foster new insights that may inform and improve care.
2. How relevant is my self-disclosure to the patient?
This question concerns the content of self-disclosure. One of the most common sentiments patients expressed to me was that they only wanted their physicians to self-disclose if it related to them, especially if it could in some way impact their care. Additionally, a number of patients only valued self-disclosures if their clinician had the exact same condition or location of pain as them. The one exception is small talk, which a number of patients said they enjoyed because it made their physicians more personable.
3. Is this the right time to self-disclose?
This question concerns the context of self-disclosure, such as the setting, time, and state of the patient-doctor relationship. Self-disclosing about personal loss, for example, can have a profoundly different impact during a routine outpatient visit compared to the bedside of a hospice patient. Self-disclosing at the start of an appointment may also impact the rest of the encounter in a different way than self-disclosing towards the end. Finally, self-disclosing carries its own risks and benefits when done in the context of an existing long-term relationship with the patient versus with a new patient—the former may be more palatable to the patient but potentially change the dynamics of the relationship moving forward; the latter may either quickly enhance rapport or risk making the patient feel uncomfortable.
4. How should I self-disclose while still centralizing the patient?
This question concerns the nature of self-disclosure. Sharing about myself should never remove time and focus from the patient and the purpose of the appointment. Often this requires self-disclosures to be brief, a preference that patients routinely voiced to me. Patients may benefit from knowing that their physician can personally relate to them and thus offer unique perspectives into their condition and care. On the other hand, extraneous details may frustrate the patient since the appointment should be entirely about them. Importantly, the self-disclosure should never make the patient feel that their experience is the same as anyone else’s, especially the doctor’s. Patients ought to feel that their care is individualized to their needs and that their physician’s own experiences don’t cloud their objectivity and attentiveness to the patient’s unique situation.
5. How might this self-disclosure impact my professionalism?
This question may be the most important to consider. Chief among the risks of physician self-disclosure is the dissolution of the patient-clinician relationship from a professional one into a personal and even intimate one. One of the main reasons patients shared with me for not wanting their physicians to self-disclose was that they thought it was unprofessional. The major concern that doctors themselves have in self-disclosing is the risk to their professional image. Once physicians disclose potentially sensitive information about themselves they surrender control of where this information can potentially go. It’s therefore vital to evaluate, not only for our patients but for ourselves, the consequences of self-disclosure outside the exam room.
The oft-quoted “Peter Parker principle” from the Spiderman franchise—“With great power comes great responsibility”—applies to doctor-patient communication in general, but is particularly salient with regards to physician self-disclosure. There’s no power like the words of our own experiences to impact another. Should we choose to deploy this power with our patients, it should be done with great caution, and always with empathy, compassion, and goodwill for our patient at top of mind.