[Editor's Note: By a strange coincidence the following exchange was secretly recorded on the same day this report was released: "Personal Comments By Physicians Distract From Patient Needs."]
Dr. Xavier Yonder Zither: Hi, Ms. Ursaline. How are you feeling these days?
Ms. Penelope Ursaline: Not so good, Doctor. My feet are swollen and I have this pain that shoots down my hip whenever I run after purse snatchers.
Dr. Xavier Y. Zither: I hear ya - you should have seen me after I finished a 10K run on Saturday! They had to practically carry me off the course.
In well-intentioned efforts to establish relationships, some physicians tell patients about their own family members, health problems, travel experiences and political beliefs.
Ms. P. Ursaline: Myself, I could hardly get up out of the chair this morning. Also, I'm having nausea after I eat. The sight of food makes me sick now. Last night I threw away a whole pot roast after making it.
Dr. X. Y. Zither: You did? Oh, goodness, you should have called me - I would have taken it. I haven't had a good roast since my divorce last year. I'm always eating out, usually at La Moufette Fétide.
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.
Ms. P. U.: Well, I think I'm allergic to these new pills you gave me.
Dr. X. Y. Z.: Do you mean your breast cancer hormone pill? Nausea may be a side effect but it's not an actual allergy. For example, when I take penicillin it causes a horrible rash so I'm only bringing ciprofloxacin with me when I go to Makira-Ulawa this fall.
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."
P. U.: Oh, are you taking your children with you?
X. Y. Z.: No, I don't have much contact with them anymore. They basically have been brainwashed by my ex-wife. I am dating a sweet girl now - you probably saw her when you checked in at the window today.
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.
PU: What can I do about all these symptoms? I just feel awful.
XYZ: That's a good question. Half the time I feel the same way - maybe we both need to be on something.
PU: [censored]
"Doctors need support groups, self-awareness groups and mindfulness groups to meet their needs," Susan H. McDaniel, Ph.D. [lead author of the article] 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."
This is a valuable lesson that in my opinion should be taught to all medical students and residents, viz., doctors should refrain from using the "captive audience trick" on their patients, no matter how frustrated they are with the sad fact that no one has praised their beauty, wit, intelligence, fascinating talents, unique interests or costly habits in the past hour. If doctors want to pontificate on how wonderful they are they should seek out the one admirer who will always listen with puerile delight. That person can be found here.
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Wow, this article by Dr. McDaniel has certainly generated a lot of web chatter. Apparently it struck a nerve.
In trying to put the best face on this, we have to remind each other that it IS appropriate for physicians to spend time outside of the bounds of the Chief Complaint as the story unfolds. Craig, as you pointed out in your great post on June 1, the Social History often holds the key to the patient's illness and it takes time to explore that.
The House of God reminds us that "the patient is the one with the disease." It's not about us, after all! Apparently, some of us forget that far too often.
Thanks for providing a great illustration.
This is interesting. My own doc is one of the authors of this study. Last time I was in for a follow-up, I wound up feeling the doc was aloof or distracted. I have been seeing this same physician for many yrs., not long after he/she began a practice. We have kids nearly the same age, so that has sometimes been a subject of discussion. Hey, it is a Family Medicine group. Hard to divorce family dynamics from the holistic health idea.
I felt sort of bad about the visit, like I was maybe wasting the doc's time. I had recovered from the initial illness, so I could have canceled the appointment instead.
My suggestion to the authors would be that it might be necessary to briefly explain to long-term patients that new research has led the doctor to interact in different ways than he/she did in the past. Otherwise it can be off-putting.
man, you got no idea. there's nothing weirder than a doc who asks you what's wrong and then shows you pictures of his new cat.
Lepht
(answering a story about annoying anecdotes, with an annoying anecdote - booya.)
I'm not sure I totally agree with the generalization that self-disclosure is a bad thing. I completely agree with the point of this illustration, and that showing pictures of my new pet dog is totally irrelevant. However, some of my patients and their parents (I am a pediatric oncologist) seem to take comfort in knowing that I have children, and that my children have been sick, so that while I may not know what it's like to have a child with cancer, I know what it's like to sit in the PICU and worry about whether or not my child is going to die. Making that disclosure has had the apparent effect of providing comfort on more than one occasion, and I have even received indirect feedback (via nursing staff, for example) that parents have indeed found it comforting to know that I have had experiences similar to theirs. I think that in reality, what matters is whether the self-disclosure is appropriate or not, rather than whether or not we tell a patient about our personal lives.
I agree with David Loeb.
To humanize any relationship there has to be a certain amount of self-disclosure by both participants. It is not a one way street.
The words that come to mind are "balance" and "common sense"- both qualities useful in self-disclosure.
I have mixed feelings about this.
On the one hand, it's important that doctors establish a trusting relationship and a strong rapport with their patients. Self-disclosure isn't essential for this - I understand it's a huge no-no for psychiatrists. On the other hand, the doctor in the anecdote isn't just self-disclosing - he's boorish, self-absorbed, and incompetent. I'm sure self-disclosure can contribute to that, but it doesn't always.
As a patient, I really appreciate it when my doctor shows some humanity, and I don't think it's ever interfered in their professionalism. To avoid all self-disclosure is highly artificial and (for me at least) reduces trust unless there's a good reason for it. I agree with Piet Hein:
My faith in doctors
is immense.
Just one thing spoils it;
their pretence
of authorised
omniscience.
I hate the "interview" feeling of being at the doctor's - the way they feel it's perfectly appropriate for them to quiz you on things that have nothing to do with why you're there, like where you work, where you went to school, etc, but awkward for you to turn around and ask them the same things. I often *do*, though ("And how about you, where did *you* go to school?") and I appreciate a doctor who will cheerfully roll with that.
Really what I want is a note in my chart that says "virulent hatred of small talk", but what can you do.