Should doctors share their personal experiences of healthcare with patients?BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4312 (Published 16 October 2018) Cite this as: BMJ 2018;363:k4312
All rapid responses
Many thanks for publishing an article that tackles such a potentially divisive topic1. Clearly the practise of self-disclosure promises many potential benefits in the way it can allow clinicians to empathise with patients. However, the potential pitfalls of what could be seen as a fundamentally risky approach to patient consultations seem worryingly numerous. Whilst some patients may respond well to attempts to empathise off the back of personal experience, there is little discussion by Robinson about the very real possibility of some taking offence at a clinician’s misplaced efforts to relate to an experience the patient might see as wholly unique to them. This paradigm seems all the more pertinent in the context of mental health, where the inherent individuality of a person’s mental state makes it particularly challenging to judge whether one’s own experiences truly relate to that of the patient; there is little more frustrating than someone telling you they understand aspects of a personal experience you feel they can’t possibly relate to.
The risk of accidentally upsetting patients is supplement to a whole raft of further potential issues with clinician self-disclosures that are appropriately identified in the article; the potential shift of focus from the patient to the doctor, the potential for the doctor’s story to hold undue influence on patient decision-making, and a possible perceived lack of associated professionalism are compelling reasons which, in tandem with the observation that patients may find such disclosures upsetting, should lead clinicians to self-disclose only with significant caution. This is underlined by the fact that there is very little evidence of significant perceived benefit from the practise of self-disclosure, with some studies suggesting it reduces patient satisfaction, and can even be viewed as actively disruptive2,3.
Even where self-disclosure is initially met with a positive response, the long-term impact of sharing personal experiences on the doctor-patient relationship may be an adverse one; a shifting of boundaries has the potential to lead to perceived friendships, the associated implications of which may extend to demands on clinicians’ time and duties that a more professional relationship might deter. As such, it is hard to see how the potential benefits of self-disclosure outweigh the blurring of professional margins, which exist for the protection of both patient and doctor.
Ultimately, the decision as to whether or not to self-disclose relies on the judgment of the clinician; if one is confident of perceived benefit, then judicious use of personal experience as a consultation tool may be appropriate. However, it may simply be safer to empathise in a more general sense, without divulging personal information; we should be careful that in reaching across the doctor-patient relationship, we don’t cause it to break down.
1. Robinson F. Should doctors share their personal experiences of healthcare with patients? BMJ 2018;363:k4312 doi: https://doi.org/10.1136/bmj.k4312
2. McDaniel S H, Beckman H B, Morse D S, Silberman J, Seaburn D B, Epstein R M. Physician Self-disclosure in Primary Care Visits: Enough about you, what about me? Arch Intern Med. 2007 167(12) 1321-1326, PMID: 20440869
3. Beach M C, Roter D, Rubin H, Frankel R, Levinson W, and Ford D E. Is Physician Self-disclosure Related to Patient Evaluation of Office Visits? J Gen Intern Med. 2004 19(9) 905-910, PMID: 15333053
Competing interests: No competing interests