“Enough about Me, Let's Get Back to You”: Physician Self-disclosure during Primary Care Encounters
Authors: Diane S. Morse
Journal: Annals of Internal Medicine (2008)

Perspectives2 December 2008"Enough about Me, Let's Get Back to You": Physician Self-disclosure during Primary Care EncountersDiane S. Morse, MD, Susan H. McDaniel, PhD, Lucy M. Candib, MD, and Mary Catherine Beach, MDDiane S. Morse, MDFrom the University of Rochester School of Medicine and Dentistry, and Hebrew University of Jerusalem (Fulbright Program), Rochester, NY 14642; University of Rochester, Rochester, NY 14620; Family Health Center of Worcester and University of Massachusetts Medicine Center, Worcester, MA 01610; and Johns Hopkins University, Baltimore, MD 21210., Susan H. McDaniel, PhDFrom the University of Rochester School of Medicine and Dentistry, and Hebrew University of Jerusalem (Fulbright Program), Rochester, NY 14642; University of Rochester, Rochester, NY 14620; Family Health Center of Worcester and University of Massachusetts Medicine Center, Worcester, MA 01610; and Johns Hopkins University, Baltimore, MD 21210., Lucy M. Candib, MDFrom the University of Rochester School of Medicine and Dentistry, and Hebrew University of Jerusalem (Fulbright Program), Rochester, NY 14642; University of Rochester, Rochester, NY 14620; Family Health Center of Worcester and University of Massachusetts Medicine Center, Worcester, MA 01610; and Johns Hopkins University, Baltimore, MD 21210., and Mary Catherine Beach, MDFrom the University of Rochester School of Medicine and Dentistry, and Hebrew University of Jerusalem (Fulbright Program), Rochester, NY 14642; University of Rochester, Rochester, NY 14620; Family Health Center of Worcester and University of Massachusetts Medicine Center, Worcester, MA 01610; and Johns Hopkins University, Baltimore, MD 21210.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-11-200812020-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Patients want a relationship with a physician with whom they can talk freely, and physicians vary in how they engage with patients. One form of engagement is self-disclosure, in which the physician reveals something personal about himself or herself. Historically, self-disclosure has been considered unacceptable in both psychiatry and medicine. Freud advocated that psychotherapists act as blank slates, and Osler advised physicians to maintain aequanimitas or impartiality (1). Recent psychodynamic literature stresses boundaries, calling clinician self-disclosure risky, potentially motivated by projection, and distracting to patients (2–5).Nevertheless, recent studies reveal that primary care physicians are talking about themselves to 25% ...References1. Osler W. Aequanimitas. New York: McGraw-Hill; 1932. Google Scholar2. Nadelson C, Notman MT. Boundaries in the doctor-patient relationship. Theor Med Bioeth. 2002;23:191-201. [PMID: 12467344] CrossrefMedlineGoogle Scholar3. Moldawsky RJ. New support for long-standing cautions about self-disclosure [Letter]. Arch Intern Med. 2008;168:110-1. [PMID: 18195205] CrossrefMedlineGoogle Scholar4. McDaniel SH, Campbell TL, Hepworth J, Lorenz A. Family-Oriented Primary Care. 2nd ed. New York: Springer-Verlag; 2005:450-64. Google Scholar5. Klitzman R, Weiss J. Disclosures of illness by doctors to their patients: a qualitative study of doctors with HIV and other serious disorders. Patient Educ Couns. 2006;64:277-84. [PMID: 16860516] CrossrefMedlineGoogle Scholar6. McDaniel SH, Beckman HB, Morse DS, Silberman J, Seaburn DB, Epstein RM. Physician self-disclosure in primary care visits: enough about you, what about me? Arch Intern Med. 2007;167:1321-6. [PMID: 17592107] CrossrefMedlineGoogle Scholar7. Beach MC, Roter D, Rubin H, Frankel R, Levinson W, Ford DE. Is physician self-disclosure related to patient evaluation of office visits? J Gen Intern Med. 2004;19:905-10. [PMID: 15333053] CrossrefMedlineGoogle Scholar8. Beach MC, Roter D, Larson S, Levinson W, Ford DE, Frankel R. What do physicians tell patients about themselves? A qualitative analysis of physician self-disclosure. J Gen Intern Med. 2004;19:911-6. [PMID: 15333054] CrossrefMedlineGoogle Scholar9. Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287-90. [PMID: 10728118] CrossrefMedlineGoogle Scholar10. Dahan R, Yoeli N, Karkabi K, Hermoni D. Patient's attitudes towards physician self disclosure during the patient-physician encounter [Abstract]. Eur J Gen Pract. 2007;13:109. Google Scholar11. Candib LM. What doctors tell about themselves to patients: implications for intimacy and reciprocity in the relationship. Fam Med. 1987;19:23-30. [PMID: 3552832] MedlineGoogle Scholar12. Jourard SM. Self-disclosure: An experimental analysis of the transparent self. New York: Wiley-Interscience; 1971. Google Scholar13. Candib LM. Medicine and the Family: A Feminist Perspective. New York: Basic Books; 1995. Google Scholar14. Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al. "Let me see if I have this right … ": words that help build empathy. Ann Intern Med. 2001;135:221-7. [PMID: 11487497] LinkGoogle Scholar15. Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG. "Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry. J Gen Intern Med. 2007;22:1731-9. [PMID: 17972141] CrossrefMedlineGoogle Scholar16. Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18:670-4. [PMID: 12911651] CrossrefMedlineGoogle Scholar17. Morse DS, Edwardsen EA, Gordon HS. Missed opportunities for interval empathy in lung cancer communication. Arch Intern Med. 2008;168:1853-8. CrossrefMedlineGoogle Scholar18. Relationship-Centered Care Research Network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21 Suppl 1 S3-8. [PMID: 16405707] CrossrefMedlineGoogle Scholar19. Engel GL. Physician-scientists and scientific physicians. Resolving the humanism-science dichotomy. Am J Med. 1987;82:107-11. [PMID: 3799669] CrossrefMedlineGoogle Scholar20. Morgan WL, Engel GL. The Clinical Approach to the Patient. Philadelphia: Saunders; 1969. Google Scholar21. Balint M. The Doctor, His Patient, and the Illness. New York: International Universities Pr; 1972. Google Scholar22. Epstein RM. Mindful practice. JAMA. 1999;282:833-9. [PMID: 10478689] CrossrefMedlineGoogle Scholar23. Farber NJ, Novack DH, Silverstein J, Davis EB, Weiner J, Boyer EG. Physicians' experiences with patients who transgress boundaries. J Gen Intern Med. 2000;15:770-5. [PMID: 11119168] CrossrefMedlineGoogle Scholar24. Candib LM. When the doctor takes off her clothes: reflections on being seen by patients in the exercise setting. Fam Syst Health. 1999;17:349-63. CrossrefGoogle Scholar25. Malterud K, Hollnagel H. The doctor who cried: a qualitative study about the doctor's vulnerability. Ann Fam Med. 2005;3:348-52. [PMID: 16046568] CrossrefMedlineGoogle Scholar26. Morse D. A piece of my mind. When to touch. JAMA. 1990;263:2225. [PMID: 2319688] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Rochester School of Medicine and Dentistry, and Hebrew University of Jerusalem (Fulbright Program), Rochester, NY 14642; University of Rochester, Rochester, NY 14620; Family Health Center of Worcester and University of Massachusetts Medicine Center, Worcester, MA 01610; and Johns Hopkins University, Baltimore, MD 21210.Acknowledgment: The authors thank Ronald Epstein, MD, and Janine Roberts, PhD, for their review of the manuscript.Disclosures: None disclosed.Corresponding Author: Diane S. Morse, MD, University of Rochester Medical Center, Box Psych, 300 Crittenden Boulevard, Rochester, NY 14642; e-mail, [email protected]rochester.edu.Current Author Addresses: Dr. Morse: Departments of Internal Medicine and Psychiatry, University of Rochester Medical Center, Box Psych, 300 Crittenden Boulevard, Rochester, NY 14642.Dr. McDaniel: Departments of Family Medicine and Psychiatry, University of Rochester, 777 South Clinton Avenue, Rochester, NY 14620.Dr. Candib: Department of Family Medicine, Family Health Center of Worcester, 26 Queen Street, Worcester, MA 01610.Dr. Beach: Department of Internal Medicine, Johns Hopkins University, 2024 East Monument Street, Baltimore, MD 21210. 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