Health Care :: Personal comments by physicians distract from patient needs

In well-intentioned efforts to establish relationships, some physicians tell patients about their own family members, health problems, travel experiences and political beliefs.

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 concern.

?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 them.

?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 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.

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