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Doctors use of self-disclosure positive with patients

Doctors use of self-disclosure positive with patients

Doctors often use their own experience to enhance communication with a patient during a clinical consultation.

These “self-disclosures” were the focus of a recent study led by Dr Bruce Arroll, a Professor of General Practice and Primary Health at the University of Auckland, and published in the British Journal of General Practice this month.

“There is a debate in medicine about the use and value of self-disclosure as a communication tool and little evidence about how it’s used in practice,” says Professor Arroll.

In the study, GP interviews were carried out by medical student, Emily-Charlotte Allen, to explore GP attitudes, skills and behaviour with self-disclosure to patients during a clinical consultation. The study also investigated whether there was a need for the development of training resources for doctors.

From an initial sample of 52 Auckland region GPs, 16 were interviewed (32 percent response) and among these, there was unanimous agreement that self-disclosure could be an advantage for the patient or the doctor-patient relationship.

To help establish the level at which GPs were comfortable disclosing personal examples, a list of statements was developed of potential advantages and disadvantages of GP self-disclosure, and GPs were asked to agree or disagree with these.

“The majority of participants agreed with all the potential advantages of self-disclosure listed, but there was a wider range of opinions on the disadvantages,” Professor Arrollsays. “GPs frequently reported that self-disclosure helped to establish empathy and understanding between doctor and patient.

“Most of the GPs also acknowledged that self-disclosure could be a disadvantage, but fewer agreed with the list of potential disadvantages,” says Dr Arroll.

Potential advantages of self-disclosure were listed as;
• Enhances patient support and empathy
• Creates sense of closeness
• Increases patient motivation and adherence
• Makes it easier for patients to share their experiences with physician
• Develops trust and mutuality
• Helps reduce any power imbalance in the relationship
Potential disadvantages of self-disclosure were;

• Skews the carer-patient relationship
• Burdens the patient
• Takes focus away from patient’s needs
• Risk of expanding professional relationship into a more personal/intimate one
• Creates patient curiosity and dependency
• Reduces the credibility of the doctor
“Self-disclosure was common in this group of GPs and ranged from physical conditions through to marital discord,” says Dr Arroll. “It is largely viewed positively by the GPs, who over years of experience have formed their own guidelines, and some participants described considerable skill in response to direct questions from patients.”

“Training on self-disclosure is not common but the group of GPs could see value in exposing the issue of self-disclosure to medical trainees to better prepare them for clinical practice,” he said.

Professor Arroll also led a systematic review into self-disclosure among GPs and found that up to 75 percent of GPs disclosed personal information about themselves to patients.

“But the benefits or harms of doing so are uncertain and there is no evidence of training on how to deal with self-disclosure,” he said.


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